MEDICARE: MS. MARIAH ELISE PAYNE

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	C.2103484	OH
2	171M00000X	Case Manager/Care Coordinator
3	101YM0800X	Mental Health Counselor	E.2404175	OH

General Provider Information

NPI Number	:	1689223703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIAH ELISE PAYNE

Provider Business Mailing Address
First Line	:	6180 EMERALD ST
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-2048
Country	:	US
Telephone Number	:	440-732-5252
Fax Number	:	440-271-2003

Provider Business Practice Location Address
First Line	:	6180 EMERALD ST
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-2048
Country	:	US
Telephone Number	:	440-732-5252
Fax Number	:	440-271-2003

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

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	02/07/2025

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