Healthcare Provider Details

I. General information

NPI: 1104662782
Provider Name (Legal Business Name): ANNA PAYTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SW 7TH ST
REDMOND OR
97756-2113
US

IV. Provider business mailing address

2265 CROSSBILL CT
REDMOND OR
97756-1264
US

V. Phone/Fax

Practice location:
  • Phone: 541-388-8459
  • Fax: 541-388-8116
Mailing address:
  • Phone: 541-519-6278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: