Provider Demographics
NPI:1609083716
Name:PEYTON, ROBERT MICHAEL (MA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:PEYTON
Suffix:
Gender:M
Credentials:MA
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 132
Mailing Address - Street 2:30 SOUTH STATE STREET
Mailing Address - City:TEASDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84773-0132
Mailing Address - Country:US
Mailing Address - Phone:435-425-3321
Mailing Address - Fax:
Practice Address - Street 1:ASPEN RANCH
Practice Address - Street 2:2000 W DRY VALLEY ROAD
Practice Address - City:LOA
Practice Address - State:UT
Practice Address - Zip Code:84747-0369
Practice Address - Country:US
Practice Address - Phone:435-836-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT271527-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist