Provider Demographics
NPI:1891478020
Name:PAYNE, JAMES (MA LPC-MHSP TEMP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MA LPC-MHSP TEMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 JUDGE AUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-7252
Mailing Address - Country:US
Mailing Address - Phone:865-266-9764
Mailing Address - Fax:
Practice Address - Street 1:3380 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-5365
Practice Address - Country:US
Practice Address - Phone:931-372-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional