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General NPI Number Information
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NPI Number | 1225397698
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Entity Type | Individual
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Provider Name | DAVID RUSSELL PAYNE PCC
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Gender | Male
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Dates
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Enumeration Date | 05/04/2012
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 3920 AKIN LN
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City | BURLINGTON
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State | KY
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Zip | 41005-9714
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Country | US
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Telephone | 502-324-7586
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Fax | 859-692-1289
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Provider Business Mailing Address
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Address Line | 3920 AKIN LN
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City | BURLINGTON
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State | KY
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Zip | 41005-9714
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Country | US
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Telephone | 502-324-7586
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Fax | 859-692-1289
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.0800292
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License Number State | OH
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