MEDICARE: MARCUS PAYTON QMHP-CS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1255076733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCUS PAYTON QMHP-CS

Provider Business Mailing Address
First Line	:	1628 RIDGE HAVEN DR APT 810
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-9043
Country	:	US
Telephone Number	:	225-303-3166
Fax Number	:

Provider Business Practice Location Address
First Line	:	1628 RIDGE HAVEN DR APT 810
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-9043
Country	:	US
Telephone Number	:	225-303-3166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2022
Last Update Date	:	04/30/2022

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Directions to “ MARCUS PAYTON QMHP-CS” Practice Location

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