Healthcare Provider Details

I. General information

NPI: 1407345689
Provider Name (Legal Business Name): MALADEAN E PAYNE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 RICHARDSON DR
ANCHORAGE AK
99504-2464
US

IV. Provider business mailing address

1410 RICHARDSON DR
ANCHORAGE AK
99504-2464
US

V. Phone/Fax

Practice location:
  • Phone: 216-374-4727
  • Fax: 907-300-2638
Mailing address:
  • Phone: 216-374-4727
  • Fax: 907-300-2638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1902021
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.1800802-TRNE
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number238638
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: