Provider Demographics
NPI:1205287661
Name:PAYNE, AMANDA (LMHC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 PASEO REYES DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-8462
Mailing Address - Country:US
Mailing Address - Phone:904-481-9131
Mailing Address - Fax:904-562-3465
Practice Address - Street 1:264 PASEO REYES DR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8462
Practice Address - Country:US
Practice Address - Phone:904-481-9131
Practice Address - Fax:904-562-3465
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13243101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health