Provider Demographics
NPI:1508116534
Name:PAYNE BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:PAYNE BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:O'RYAN
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:614-372-5645
Mailing Address - Street 1:1706 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-2039
Mailing Address - Country:US
Mailing Address - Phone:614-372-5645
Mailing Address - Fax:614-278-7550
Practice Address - Street 1:1706 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-2039
Practice Address - Country:US
Practice Address - Phone:614-372-5645
Practice Address - Fax:614-278-7550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty