Provider Demographics
NPI:1235808437
Name:SIX, PEYTON (BCBA)
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:
Last Name:SIX
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:PEYTON
Other - Middle Name:
Other - Last Name:BEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3921 PINTAIL DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-6738
Mailing Address - Country:US
Mailing Address - Phone:188-851-5179
Mailing Address - Fax:
Practice Address - Street 1:2035 W ISLES AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704
Practice Address - Country:US
Practice Address - Phone:888-308-3728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst