Provider Demographics
NPI:1184363699
Name:MITCHELL PAYTON, FELICIA A (LMFT)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:A
Last Name:MITCHELL PAYTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:A
Other - Last Name:MITCHELL PAYTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:25055 LA MAR RD
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2901
Mailing Address - Country:US
Mailing Address - Phone:909-253-6816
Mailing Address - Fax:
Practice Address - Street 1:1025 E OCEAN AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7088
Practice Address - Country:US
Practice Address - Phone:909-540-1945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132867106H00000X
CALMFT149457106H00000X
CAAMFT132867101YA0400X
CA149457101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health