MEDICARE: KATE PAYNE LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1588211940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATE PAYNE LLC

Provider Business Mailing Address
First Line	:	PO BOX 10
Second Line	:
City	:	MASON
State	:	MI
Zip	:	48854-0010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1151 MICHIGAN AVE STE 109
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-4070
Country	:	US
Telephone Number	:	517-897-0507
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	MARY BETH HOUPT
Credential	:
Telephone Number	:	517-676-9797

Provider Enumeration Date	:	08/21/2019
Last Update Date	:	08/21/2019

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Directions to “KATE PAYNE LLC ” Practice Location

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