Healthcare Provider Details

I. General information

NPI: 1780596452
Provider Name (Legal Business Name): LACRESHA T PAYNE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 E 38TH ST
MINNEAPOLIS MN
55409-1363
US

IV. Provider business mailing address

7709 DALEVIEW DR
BROOKLYN PARK MN
55443-3330
US

V. Phone/Fax

Practice location:
  • Phone: 612-281-3886
  • Fax:
Mailing address:
  • Phone: 612-281-3886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22440
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: