MEDICARE: NICOLE PAYSINGER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	105420	CA

General Provider Information

NPI Number	:	1912659111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE PAYSINGER

Provider Business Mailing Address
First Line	:	16111 PRAIRIE AVE APT 220
Second Line	:
City	:	LAWNDALE
State	:	CA
Zip	:	90260-2718
Country	:	US
Telephone Number	:	310-595-8392
Fax Number	:

Provider Business Practice Location Address
First Line	:	3053 LA CORONA AVE
Second Line	:
City	:	ALTADENA
State	:	CA
Zip	:	91001-4332
Country	:	US
Telephone Number	:	626-791-3200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2022
Last Update Date	:	01/19/2022

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Directions to “ NICOLE PAYSINGER ” Practice Location

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