Provider Demographics
NPI:1700502135
Name:PAYTON COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:PAYTON COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:208-936-0010
Mailing Address - Street 1:2819 BRISTOL AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-1629
Mailing Address - Country:US
Mailing Address - Phone:208-936-0010
Mailing Address - Fax:208-453-7394
Practice Address - Street 1:301 S 34TH AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-7077
Practice Address - Country:US
Practice Address - Phone:208-936-0010
Practice Address - Fax:208-453-7394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty