MEDICARE: ANGELA S. PAYNE LLPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6401011146	MI

General Provider Information

NPI Number	:	1295026011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA S. PAYNE LLPC

Provider Business Mailing Address
First Line	:	19785 W 12 MILE RD
Second Line	:	490
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-2584
Country	:	US
Telephone Number	:	586-703-1514
Fax Number	:

Provider Business Practice Location Address
First Line	:	19785 W 12 MILE RD
Second Line	:	490
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-2584
Country	:	US
Telephone Number	:	586-703-1514
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2011
Last Update Date	:	04/27/2011

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