Provider Demographics
NPI:1871262907
Name:PAYNE, JESSICA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:RITTENHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:143 S 108TH PL
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-8632
Mailing Address - Country:US
Mailing Address - Phone:602-805-7700
Mailing Address - Fax:602-805-7777
Practice Address - Street 1:1090 S GILBERT RD STE 106-156
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3438
Practice Address - Country:US
Practice Address - Phone:480-772-8433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-11
Last Update Date:2023-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20023101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health