Provider Demographics
NPI:1376064188
Name:PAYNE, JOHN R II (MA, MC, LPC, NCC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:PAYNE
Suffix:II
Gender:M
Credentials:MA, MC, LPC, NCC
Other - Prefix:
Other - First Name:JR
Other - Middle Name:
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MC, LPC, NCC
Mailing Address - Street 1:5007 E HILTON AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3433
Mailing Address - Country:US
Mailing Address - Phone:480-770-0717
Mailing Address - Fax:
Practice Address - Street 1:5007 E HILTON AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3433
Practice Address - Country:US
Practice Address - Phone:480-770-0717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional