Provider Demographics
NPI:1427492347
Name:PAYNE, KRISTEN L (PHD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:PAYNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N BARRANCA AVE # 1801
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1722
Mailing Address - Country:US
Mailing Address - Phone:800-924-7811
Mailing Address - Fax:877-349-1868
Practice Address - Street 1:7008 SALEM AVE STE 117
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2226
Practice Address - Country:US
Practice Address - Phone:800-924-7811
Practice Address - Fax:877-349-1868
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH22332103TC0700X
PA22332103TC0700X
MO22332103TC0700X
TX22332103TC0700X
TN22332103TC0700X
WI2966-57103TC0700X
MI22332103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ106932Medicaid
MI1427492347Medicaid