Healthcare Provider Details

I. General information

NPI: 1891891545
Provider Name (Legal Business Name): MICHELE PAYNE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 05/09/2023
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 PULLEM BRANCH RD
MERRYVILLE LA
70653
US

IV. Provider business mailing address

PO BOX 624
MERRYVILLE LA
70653-0624
US

V. Phone/Fax

Practice location:
  • Phone: 337-353-2640
  • Fax:
Mailing address:
  • Phone: 337-353-2640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1096
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number806
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: