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NPI Code Detail

MEDICARE: TALESHA PAYNE AMFT, MBA

MEDICARE: TALESHA PAYNE AMFT, MBA
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
1106S00000XBehavior Technician
2225400000XRehabilitation Practitioner
3106H00000XMarriage & Family Therapist93218CA

General Provider Information

NPI Number : 1245585363
Entity Type Code : Individual
Provider Name (Legal Business Name) : TALESHA PAYNE AMFT, MBA
Provider Business Mailing Address
First Line : PO BOX 1521
Second Line :
City : WEST COVINA
State : CA
Zip : 91793-1521
Country : US
Telephone Number : 323-691-6152
Fax Number :
Provider Business Practice Location Address
First Line : 2513 COLORADO BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90041-1004
Country : US
Telephone Number : 323-627-1469
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2012
Last Update Date : 03/10/2022

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