Provider Demographics
NPI:1689223703
Name:PAYNE, MARIAH ELISE
Entity type:Individual
Prefix:MS
First Name:MARIAH
Middle Name:ELISE
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 1:6180 EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-2048
Mailing Address - Country:US
Mailing Address - Phone:440-732-5252
Mailing Address - Fax:440-271-2003
Practice Address - Street 1:6180 EMERALD ST
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-2048
Practice Address - Country:US
Practice Address - Phone:440-732-5252
Practice Address - Fax:440-271-2003
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2103484101YM0800X
171M00000X
OHE.2404175101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator