Provider Demographics
NPI:1891359022
Name:PAYNE, THOMAS MORRIS (LMHC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MORRIS
Last Name:PAYNE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 N 18TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-2004
Mailing Address - Country:US
Mailing Address - Phone:813-965-8149
Mailing Address - Fax:
Practice Address - Street 1:9000 N 18TH ST STE 3
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-2004
Practice Address - Country:US
Practice Address - Phone:813-965-8149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH15976101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health