Healthcare Provider Details

I. General information

NPI: 1952670549
Provider Name (Legal Business Name): LARRY ALLEN PAYNE LPC, M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8015 WOODROW RD
WOLFFORTH TX
79382-4381
US

IV. Provider business mailing address

8015 WOODROW RD
WOLFFORTH TX
79382-4381
US

V. Phone/Fax

Practice location:
  • Phone: 806-553-5291
  • Fax:
Mailing address:
  • Phone: 806-553-5291
  • Fax: 806-373-5305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number64754
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: