Healthcare Provider Details

I. General information

NPI: 1366105249
Provider Name (Legal Business Name): ELIZABETH PAYAN AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH MORALES

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 E FOOTHILL BLVD
PASADENA CA
91107-3406
US

IV. Provider business mailing address

6257 COMSTOCK AVE APT G
WHITTIER CA
90601-3419
US

V. Phone/Fax

Practice location:
  • Phone: 626-744-5230
  • Fax:
Mailing address:
  • Phone: 323-400-7643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number126458
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number126458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: