Provider Demographics
NPI:1184241556
Name:PEYTON, MICHELE THERESE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:THERESE
Last Name:PEYTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:THERESE
Other - Last Name:KLINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4652 E Q ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-4528
Mailing Address - Country:US
Mailing Address - Phone:206-445-5272
Mailing Address - Fax:
Practice Address - Street 1:4652 E Q ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-4528
Practice Address - Country:US
Practice Address - Phone:206-445-5272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW606574351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical