Provider Demographics
NPI:1629195128
Name:PAYNE, CLANDIS (MA)
Entity Type:Individual
Prefix:MRS
First Name:CLANDIS
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:CLANDIS
Other - Middle Name:V
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:24584 EBELDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-3744
Mailing Address - Country:US
Mailing Address - Phone:310-279-2668
Mailing Address - Fax:661-200-3397
Practice Address - Street 1:24584 EBELDEN AVE
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-3744
Practice Address - Country:US
Practice Address - Phone:310-279-2668
Practice Address - Fax:661-200-3397
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 52201106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist