Provider Demographics
NPI:1487129409
Name:PAYAN, ANITA (PHD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:PAYAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:MEVAWALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6655 TRAVIS ST STE 880
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6655 TRAVIS ST STE 880
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1344
Practice Address - Country:US
Practice Address - Phone:713-500-8285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37693103T00000X, 103TC2200X
TX71081103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool