Healthcare Provider Details

I. General information

NPI: 1831916840
Provider Name (Legal Business Name): PAYTON'S PLACE SAFE SPACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2024
Last Update Date: 07/19/2025
Certification Date: 07/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 PIERCE ST
RIVERSIDE CA
92505-4408
US

IV. Provider business mailing address

25055 LA MAR RD
LOMA LINDA CA
92354-2901
US

V. Phone/Fax

Practice location:
  • Phone: 909-435-5136
  • Fax:
Mailing address:
  • Phone: 909-435-5136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: FELICIA A PAYTON
Title or Position: OWNER
Credential: LMFT
Phone: 909-435-5136