Provider Demographics
NPI:1588420244
Name:PAYNE, CAROL LYNN KAY
Entity type:Individual
Prefix:
First Name:CAROL LYNN
Middle Name:KAY
Last Name:PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-2906
Mailing Address - Country:US
Mailing Address - Phone:517-320-0418
Mailing Address - Fax:
Practice Address - Street 1:160 DIVISION ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2906
Practice Address - Country:US
Practice Address - Phone:517-320-0418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst