Provider Demographics
NPI:1649580317
Name:PAYNE, SCOTT RICHARD (LISAC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:RICHARD
Last Name:PAYNE
Suffix:
Gender:M
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N. GILBERT RD.
Mailing Address - Street 2:SUITE: P
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-528-5606
Mailing Address - Fax:
Practice Address - Street 1:1400 N. GILBERT RD.
Practice Address - Street 2:SUITE: P
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234
Practice Address - Country:US
Practice Address - Phone:480-528-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC- 10360101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)