Provider Demographics
NPI:1417224031
Name:PAYNE, KAYE KELLEY (LISWS)
Entity Type:Individual
Prefix:
First Name:KAYE
Middle Name:KELLEY
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LISWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12811 COUNTY ROAD 4
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:OH
Mailing Address - Zip Code:45688-9341
Mailing Address - Country:US
Mailing Address - Phone:740-643-2797
Mailing Address - Fax:
Practice Address - Street 1:17273 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9718
Practice Address - Country:US
Practice Address - Phone:740-773-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0003766-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical