Provider Demographics
NPI:1508162967
Name:PAYNE, KELLY L (LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17002 W STEVENAGE ST # 307
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-0819
Mailing Address - Country:US
Mailing Address - Phone:623-487-7763
Mailing Address - Fax:
Practice Address - Street 1:13260 N 94TH DR STE 100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4242
Practice Address - Country:US
Practice Address - Phone:623-487-7763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)