Provider Demographics
NPI:1699402073
Name:PAYNE, LELAND (RBT)
Entity type:Individual
Prefix:
First Name:LELAND
Middle Name:
Last Name:PAYNE
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 BEE CAVES RD STE B200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6751
Mailing Address - Country:US
Mailing Address - Phone:512-328-5599
Mailing Address - Fax:
Practice Address - Street 1:3006 BEE CAVES RD STE B200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6751
Practice Address - Country:US
Practice Address - Phone:512-328-5599
Practice Address - Fax:512-328-5585
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-173276106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician