Provider Demographics
NPI:1952670549
Name:PAYNE, LARRY ALLEN (LPC, MA)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:ALLEN
Last Name:PAYNE
Suffix:
Gender:M
Credentials:LPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8015 WOODROW RD
Mailing Address - Street 2:
Mailing Address - City:WOLFFORTH
Mailing Address - State:TX
Mailing Address - Zip Code:79382-4381
Mailing Address - Country:US
Mailing Address - Phone:806-553-5291
Mailing Address - Fax:806-373-5305
Practice Address - Street 1:8015 WOODROW RD
Practice Address - Street 2:
Practice Address - City:WOLFFORTH
Practice Address - State:TX
Practice Address - Zip Code:79382-4381
Practice Address - Country:US
Practice Address - Phone:806-553-5291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64754101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX08755419OtherDRIVERS LICENSE