Provider Demographics
NPI:1699062778
Name:PAYNE, HEATHER JOYCE (MA MHC)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:JOYCE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MA MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5596 GULF STREAM ST
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-9238
Mailing Address - Country:US
Mailing Address - Phone:239-810-9011
Mailing Address - Fax:
Practice Address - Street 1:5596 GULF STREAM ST
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-9238
Practice Address - Country:US
Practice Address - Phone:239-810-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12301101YM0800X
FLIMH9062101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health