Healthcare Provider Details

I. General information

NPI: 1194087445
Provider Name (Legal Business Name): REBECCA PAYNE M.A., L.C.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 N CUMMINGS LN
WASHINGTON IL
61571-7501
US

IV. Provider business mailing address

631 N CUMMINGS LN
WASHINGTON IL
61571-7501
US

V. Phone/Fax

Practice location:
  • Phone: 309-265-2108
  • Fax:
Mailing address:
  • Phone: 309-265-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.004408
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.004408
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number39005549A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39005549A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number39005549A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number178.004408
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number39005549A
License Number StateIN
# 8
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.004408
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: