Healthcare Provider Details

I. General information

NPI: 1699402073
Provider Name (Legal Business Name): LELAND DIXON PAYNE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 BEE CAVES RD STE B200
AUSTIN TX
78746-6751
US

IV. Provider business mailing address

2105 E PARK ST
CEDAR PARK TX
78613-4598
US

V. Phone/Fax

Practice location:
  • Phone: 512-328-5599
  • Fax: 512-328-5585
Mailing address:
  • Phone: 512-588-1362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number9097
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-173276
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: