MEDICARE: MS. LOUIE AVIS PAYNE LBSW/IPR

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	33489	TX

General Provider Information

NPI Number	:	1508092081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LOUIE AVIS PAYNE LBSW/IPR

Provider Business Mailing Address
First Line	:	1305 S 33RD ST
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76504-6763
Country	:	US
Telephone Number	:	254-493-7662
Fax Number	:	254-771-4246

Provider Business Practice Location Address
First Line	:	1305 S 33RD ST
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76504-6763
Country	:	US
Telephone Number	:	254-493-7662
Fax Number	:	254-771-4246

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

Provider Enumeration Date	:	06/10/2009
Last Update Date	:	06/10/2009

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