Healthcare Provider Details

I. General information

NPI: 1871342576
Provider Name (Legal Business Name): MICHAEL PAYNE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 882
PENDLETON OR
97801-0882
US

IV. Provider business mailing address

PO BOX 882
PENDLETON OR
97801-0882
US

V. Phone/Fax

Practice location:
  • Phone: 541-304-2372
  • Fax:
Mailing address:
  • Phone: 541-304-2372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number22-CRM-1095
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-25-5057
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: