Provider Demographics
NPI:1457641490
Name:PAYNE, TIYANNA SHANEL (LMSW)
Entity type:Individual
Prefix:
First Name:TIYANNA
Middle Name:SHANEL
Last Name:PAYNE
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:TIYANNA
Other - Middle Name:SHANELL
Other - Last Name:WHITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:5859 W SAGINAW HWY # 145
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-2460
Mailing Address - Country:US
Mailing Address - Phone:269-209-4711
Mailing Address - Fax:
Practice Address - Street 1:5656 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-3894
Practice Address - Country:US
Practice Address - Phone:517-267-3925
Practice Address - Fax:269-223-6202
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010893771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical