Provider Demographics
NPI:1912273228
Name:PAYNE, THOMAS J (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:PAYNE
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:350 W WOODROW WILSON AVE
Mailing Address - Street 2:JACKSON MEDICAL MALL, STE ME-102
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-7681
Mailing Address - Country:US
Mailing Address - Phone:601-615-1180
Mailing Address - Fax:601-815-5986
Practice Address - Street 1:350 W WOODROW WILSON AVE
Practice Address - Street 2:JACKSON MEDICAL MALL, STE ME-102
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7681
Practice Address - Country:US
Practice Address - Phone:601-615-1180
Practice Address - Fax:601-815-5986
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS28-386103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical