Provider Demographics
NPI:1508092081
Name:PAYNE, LOUIE AVIS (LBSW/IPR)
Entity Type:Individual
Prefix:MS
First Name:LOUIE
Middle Name:AVIS
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LBSW/IPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 S 33RD ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-6763
Mailing Address - Country:US
Mailing Address - Phone:254-493-7662
Mailing Address - Fax:254-771-4246
Practice Address - Street 1:1305 S 33RD ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-6763
Practice Address - Country:US
Practice Address - Phone:254-493-7662
Practice Address - Fax:254-771-4246
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33489171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator