KELLY L PAYNE (LPC) – Mental Health Counselor, NPI 1508162967
Mental Health Counselor
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
630 MENTAL HEALTH COUNSELOR in IA
Provider Addresses for KELLY L PAYNE (LPC)
12200 HERITAGE PARK RD
# 307
OKLAHOMA CITY, OK 731207595
Phone: (405) 286-3810
Type: Mailing
3451 EASTON BLVD
DES MOINES, IA 503173214
Phone: (515) 262-0349
Type: Location
17002 W STEVENAGE ST # 307
SURPRISE, AZ 853740819
Phone: (623) 487-7763
Type: Mailing
13260 N 94TH DR STE 100
PEORIA, AZ 853814242
Phone: (623) 487-7763
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-03-25
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20240325000785 | I | Mental Health Counselor | AZ | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 73120)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| P S Y C H I A T R Y | NE | |
| Mental Health Counselor | AZ | |
| Nurse Practitioner | AZ | |
| Clinical Social Worker | AZ | |
| Mental Health Counselor | AZ | |
| - | WI | |
| Nurse Practitioner | AZ | |
| Nurse Practitioner | AZ | |
| Mental Health Counselor | MI | |
| Nurse Practitioner | AZ |
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