Provider Demographics
NPI:1811221633
Name:PAYTON, RAYMOND LEE
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:LEE
Last Name:PAYTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E HILLCREST DR
Mailing Address - Street 2:UNIT A
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5859
Mailing Address - Country:US
Mailing Address - Phone:818-694-3991
Mailing Address - Fax:
Practice Address - Street 1:260 E HILLCREST DR
Practice Address - Street 2:UNIT A
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5859
Practice Address - Country:US
Practice Address - Phone:818-694-3991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2101101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2101OtherCAARR PROVIDER #5001 FOR THE CAS CERTIFICATION