Provider Demographics
NPI:1417785882
Name:MADDISON PAYNE LLC
Entity type:Organization
Organization Name:MADDISON PAYNE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADDISON
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:417-459-8835
Mailing Address - Street 1:1725 S SHEFFORD CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-1288
Mailing Address - Country:US
Mailing Address - Phone:417-459-8835
Mailing Address - Fax:
Practice Address - Street 1:11940 W CENTRAL AVE STE 118
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-5180
Practice Address - Country:US
Practice Address - Phone:316-302-5462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty