Healthcare Provider Details

I. General information

NPI: 1841101078
Provider Name (Legal Business Name): HILARY VINCENT PAYNE II LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 E MISSOURI AVE
PHOENIX AZ
85014-2708
US

IV. Provider business mailing address

4717 E OSBORN RD
PHOENIX AZ
85018-6019
US

V. Phone/Fax

Practice location:
  • Phone: 602-932-3436
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-24035
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: