| Otis Edd Payne, M.d.,ps | |
|
18015 53rd Ave Ne Lake Forest Park WA 98155-4361 | |
| (206) 427-2171 | |
| (425) 670-8293 |
| Full Name | Otis Edd Payne, M.d.,ps |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 18015 53rd Ave Ne, Lake Forest Park, Washington |
| Authorized Official Name and Position | Otis Edd Payne (PRESIDENT) |
| Authorized Official Contact | 2064272171 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Otis Edd Payne, M.d.,ps 18015 53rd Ave Ne Lake Forest Park WA 98155-4361 Ph: (206) 427-2171 | Otis Edd Payne, M.d.,ps 18015 53rd Ave Ne Lake Forest Park WA 98155-4361 Ph: (206) 427-2171 |
| NPI Number | 1073705166 |
|---|---|
| Provider Enumeration Date | 08/13/2007 |
| Last Update Date | 08/13/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073705166 | NPI | - | NPPES |
| 1199009 | Medicaid | WA | |
| G8801577 | Other | WA | MEDICARE GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | MD00010587 (Washington) | Primary |
Aurelie Trier Counseling Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4230 Ne 197th St, Lake Forest Park, WA 98155 Phone: 206-317-4342 |