Healthcare Provider Details

I. General information

NPI: 1457641490
Provider Name (Legal Business Name): TIYANNA SHANEL PAYNE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIYANNA SHANELL WHITT LMSW

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5656 S CEDAR ST
LANSING MI
48911-3894
US

IV. Provider business mailing address

5859 W SAGINAW HWY # 145
LANSING MI
48917-2460
US

V. Phone/Fax

Practice location:
  • Phone: 517-267-3925
  • Fax: 269-223-6202
Mailing address:
  • Phone: 269-209-4711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801089377
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: