Provider Demographics
NPI:1124720123
Name:PAYTEN, ANNAMAY BREANN (LPC)
Entity type:Individual
Prefix:
First Name:ANNAMAY
Middle Name:BREANN
Last Name:PAYTEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:LEE
Other - Last Name:BLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:88 GUINDON BLVD
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-5866
Mailing Address - Country:US
Mailing Address - Phone:920-318-3282
Mailing Address - Fax:
Practice Address - Street 1:88 GUINDON BLVD
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-5866
Practice Address - Country:US
Practice Address - Phone:920-318-3282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11364-125101YM0800X
WI7261-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional