Provider Demographics
NPI:1295215218
Name:PAYNE-TYSON, JUSTICE (MS,LPC,CART)
Entity type:Individual
Prefix:
First Name:JUSTICE
Middle Name:
Last Name:PAYNE-TYSON
Suffix:
Gender:M
Credentials:MS,LPC,CART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 FM 1960 RD W STE 350
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4613
Mailing Address - Country:US
Mailing Address - Phone:832-360-2033
Mailing Address - Fax:832-481-2833
Practice Address - Street 1:4606 FM 1960 RD W STE 350
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4613
Practice Address - Country:US
Practice Address - Phone:832-360-2033
Practice Address - Fax:832-481-2833
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77092101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional