Provider Demographics
NPI:1699006395
Name:PAYNE, MICHAEL W (MFT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1962
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-6962
Mailing Address - Country:US
Mailing Address - Phone:925-567-0013
Mailing Address - Fax:925-625-8072
Practice Address - Street 1:11828 DUBLIN BLVD
Practice Address - Street 2:SUITE O
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2830
Practice Address - Country:US
Practice Address - Phone:925-567-0013
Practice Address - Fax:925-625-8072
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32671106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist