Provider Demographics
NPI:1144523408
Name:PAYNE, JENNIFER L (MA, LMHCA)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 WESTLAKE AVE N STE 240
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4346
Mailing Address - Country:US
Mailing Address - Phone:206-484-5465
Mailing Address - Fax:
Practice Address - Street 1:534 WESTLAKE AVE N STE 240
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4346
Practice Address - Country:US
Practice Address - Phone:206-484-5465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60158904101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health