Provider Demographics
NPI:1609600535
Name:PAYNE, MAX AIDEN
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:AIDEN
Last Name:PAYNE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10102 8TH AVE S APT E32
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98168-5523
Mailing Address - Country:US
Mailing Address - Phone:727-871-7293
Mailing Address - Fax:
Practice Address - Street 1:4219 SW JUNEAU ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1621
Practice Address - Country:US
Practice Address - Phone:206-207-5395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health