Provider Demographics
NPI:1316320559
Name:PAYNE-BREWER, THOMAS (LCPC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:PAYNE-BREWER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 N UNDERHILL ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61606-1241
Mailing Address - Country:US
Mailing Address - Phone:309-202-7383
Mailing Address - Fax:
Practice Address - Street 1:100 HILLCREST DR STE C
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-2227
Practice Address - Country:US
Practice Address - Phone:309-444-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL180.014708101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health