MEDICARE: JAZMIN PAYNE LMSW, LCPAA

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	104100000X	Social Worker	105441	TX

General Provider Information

NPI Number	:	1366161705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAZMIN PAYNE LMSW, LCPAA

Provider Business Mailing Address
First Line	:	1345 SPACE PARK DR STE C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3469
Country	:	US
Telephone Number	:	281-333-2284
Fax Number	:

Provider Business Practice Location Address
First Line	:	1345 SPACE PARK DR STE C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3469
Country	:	US
Telephone Number	:	281-333-2284
Fax Number	:

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

Provider Enumeration Date	:	08/26/2022
Last Update Date	:	08/26/2022

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