Healthcare Provider Details

I. General information

NPI: 1124333430
Provider Name (Legal Business Name): NICOLE LOUISE PAYNE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3631 S HARBOR BLVD STE 200
SANTA ANA CA
92704-7936
US

IV. Provider business mailing address

PO BOX 2262
LA HABRA CA
90632-2262
US

V. Phone/Fax

Practice location:
  • Phone: 657-356-6490
  • Fax:
Mailing address:
  • Phone: 562-665-3491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number113850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: