Provider Demographics
NPI:1528192937
Name:PAYNE, TROY
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:PAYNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8464 MEDITERRANEAN WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-1668
Mailing Address - Country:US
Mailing Address - Phone:916-606-3168
Mailing Address - Fax:
Practice Address - Street 1:7245 E SOUTHGATE DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2620
Practice Address - Country:US
Practice Address - Phone:916-427-7141
Practice Address - Fax:916-427-7122
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81535106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist