MEDICARE: SHANNON PAYNE LCSW LLC

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1619804929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANNON PAYNE LCSW LLC

Provider Business Mailing Address
First Line	:	11 N CENTRAL AVE STE 314
Second Line	:
City	:	STAUNTON
State	:	VA
Zip	:	24401-4212
Country	:	US
Telephone Number	:	540-416-2423
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 N CENTRAL AVE STE 314
Second Line	:
City	:	STAUNTON
State	:	VA
Zip	:	24401-4212
Country	:	US
Telephone Number	:	540-416-2423
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETER
Name	:	SHANNON PAYNE
Credential	:	PHD, MSW, LCSW
Telephone Number	:	513-967-5755

Provider Enumeration Date	:	05/08/2026
Last Update Date	:	05/08/2026

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