Healthcare Provider Details

I. General information

NPI: 1700257466
Provider Name (Legal Business Name): LAURIANNE PAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 NH RT16A SUITE B
INTERVALE NH
03860-0561
US

IV. Provider business mailing address

PO BOX 561
NORTH CONWAY NH
03860-0561
US

V. Phone/Fax

Practice location:
  • Phone: 603-986-1779
  • Fax:
Mailing address:
  • Phone: 603-986-1779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2096
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: