Provider Demographics
NPI:1174239586
Name:LANDRUM, PAYTON ELAYNE (LPC-A)
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:ELAYNE
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 W LOVERS LN STE 307
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-4306
Mailing Address - Country:US
Mailing Address - Phone:469-978-2264
Mailing Address - Fax:
Practice Address - Street 1:5600 W LOVERS LN STE 307
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-4306
Practice Address - Country:US
Practice Address - Phone:469-978-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90545101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX90545OtherBHEC, LPC-A