Healthcare Provider Details

I. General information

NPI: 1942230552
Provider Name (Legal Business Name): DEANA PAYNE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 HIGHWAY 49
VIBURNUM MO
65566-1001
US

IV. Provider business mailing address

PO BOX 706
VIBURNUM MO
65566-0706
US

V. Phone/Fax

Practice location:
  • Phone: 573-244-5555
  • Fax:
Mailing address:
  • Phone: 573-244-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2005022527
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: