Basic Information
| Provider Information | |||||||||
| NPI: | 1003006883 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAYNE | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | WEBB | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3856 | ||||||||
| Address2: | |||||||||
| City: | HAILEY | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833333856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087883130 | ||||||||
| FaxNumber: | 2087883130 | ||||||||
| Practice Location | |||||||||
| Address1: | 416 S MAIN ST | ||||||||
| Address2: | SUITE B-3 | ||||||||
| City: | HAILEY | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833338440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087883130 | ||||||||
| FaxNumber: | 2087883130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2007 | ||||||||
| LastUpdateDate: | 07/27/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC3574 | ID | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.