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General NPI Number Information
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NPI Number | 1952670549
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Entity Type | Individual
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Provider Name | LARRY ALLEN PAYNE LPC, M.A.
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Gender | Male
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Dates
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Enumeration Date | 12/28/2011
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Last Update Date | 05/23/2019
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Provider Practice Location Address
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Address Line | 8015 WOODROW RD
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City | WOLFFORTH
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State | TX
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Zip | 79382-4381
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Country | US
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Telephone | 806-553-5291
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Fax |
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Provider Business Mailing Address
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Address Line | 8015 WOODROW RD
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City | WOLFFORTH
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State | TX
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Zip | 79382-4381
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Country | US
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Telephone | 806-553-5291
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Fax | 806-373-5305
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 64754
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License Number State | TX
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