Provider Demographics
NPI:1700530342
Name:PAYNE, TENESIA (RBT)
Entity Type:Individual
Prefix:
First Name:TENESIA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 PEARL CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4247
Mailing Address - Country:US
Mailing Address - Phone:813-203-2338
Mailing Address - Fax:
Practice Address - Street 1:800 W PLATT ST # 56
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-4102
Practice Address - Country:US
Practice Address - Phone:813-475-4665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-22-203157106S00000X
FLRBT-22-203157106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician