Provider Demographics
NPI:1972644607
Name:PEYTON, LYN (PHD)
Entity Type:Individual
Prefix:
First Name:LYN
Middle Name:
Last Name:PEYTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4388 SEDUM GLN
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1151
Mailing Address - Country:US
Mailing Address - Phone:248-568-4524
Mailing Address - Fax:
Practice Address - Street 1:4388 SEDUM GLN
Practice Address - Street 2:PEYTON & DAVENPORT, INC
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1151
Practice Address - Country:US
Practice Address - Phone:248-568-4524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015451103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical