Provider Demographics
NPI:1467575886
Name:PAYTON, JOSHUA T (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:T
Last Name:PAYTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 919
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-0919
Mailing Address - Country:US
Mailing Address - Phone:971-237-2424
Mailing Address - Fax:503-883-9086
Practice Address - Street 1:117 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-5560
Practice Address - Country:US
Practice Address - Phone:971-237-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1788103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR218106Medicaid
OR820505000OtherREGENCE BC BS
OR820505000OtherREGENCE BC BS