Provider Demographics
NPI:1467824615
Name:PAYTON, GREGORY (MSW LICDC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:PAYTON
Suffix:
Gender:M
Credentials:MSW LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6036 FERNVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-1312
Mailing Address - Country:US
Mailing Address - Phone:513-390-1820
Mailing Address - Fax:
Practice Address - Street 1:6036 FERNVIEW AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-1312
Practice Address - Country:US
Practice Address - Phone:513-390-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011090101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)