Provider Demographics
NPI:1518090216
Name:PAYNE, SHAUNTELE MONIQUE (LPC)
Entity Type:Individual
Prefix:MS
First Name:SHAUNTELE
Middle Name:MONIQUE
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 1:828 KINGSWAY DR W
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-3022
Mailing Address - Country:US
Mailing Address - Phone:504-319-8989
Mailing Address - Fax:504-328-1565
Practice Address - Street 1:2245 MANHATTAN BLVD STE 108
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-3455
Practice Address - Country:US
Practice Address - Phone:504-319-8989
Practice Address - Fax:504-328-1565
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3268101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional