Basic Information
| Provider Information | |||||||||
| NPI: | 1427522911 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAYNE | ||||||||
| FirstName: | SAVANNAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22921 ANZA AVE | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905053424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4249998834 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22921 ANZA AVE | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905053424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4249998834 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2019 | ||||||||
| LastUpdateDate: | 05/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMFT129907 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.