Provider Demographics
NPI:1770004681
Name:PAYNE JONES, ANDREA D (LPC/MHSP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:D
Last Name:PAYNE JONES
Suffix:
Gender:F
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5128 JESSIE LEE LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-4521
Mailing Address - Country:US
Mailing Address - Phone:901-605-8503
Mailing Address - Fax:
Practice Address - Street 1:5128 JESSIE LEE LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-4521
Practice Address - Country:US
Practice Address - Phone:901-605-8503
Practice Address - Fax:901-605-8503
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000003435101YM0800X
TN0000003435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health