Provider Demographics
NPI:1790462695
Name:PAYNE, EMILEE ANNE
Entity Type:Individual
Prefix:
First Name:EMILEE
Middle Name:ANNE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 COUNTRY ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:PAINT LICK
Mailing Address - State:KY
Mailing Address - Zip Code:40461-8506
Mailing Address - Country:US
Mailing Address - Phone:859-986-6085
Mailing Address - Fax:
Practice Address - Street 1:1906 COLLEGE HEIGHTS BLVD # 11024
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1000
Practice Address - Country:US
Practice Address - Phone:270-745-3159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health