Provider Demographics
NPI:1154760288
Name:PAYNE, GEORGE THOMAS (L C S W)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:THOMAS
Last Name:PAYNE
Suffix:
Gender:M
Credentials:L C S W
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 ALTURAS DR N
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4332
Mailing Address - Country:US
Mailing Address - Phone:208-420-5347
Mailing Address - Fax:
Practice Address - Street 1:535 ALTURAS DR N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4332
Practice Address - Country:US
Practice Address - Phone:208-420-5347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-2731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical