Provider Demographics
NPI:1205423639
Name:PEYTON, MARQUICE SHANEA (BCBA)
Entity type:Individual
Prefix:
First Name:MARQUICE
Middle Name:SHANEA
Last Name:PEYTON
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:MARQUICE
Other - Middle Name:SHANEA
Other - Last Name:PEYTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:1824 TOUBY PIKE STE B
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-2573
Mailing Address - Country:US
Mailing Address - Phone:765-628-7400
Mailing Address - Fax:765-450-6453
Practice Address - Street 1:2630 S ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-5701
Practice Address - Country:US
Practice Address - Phone:317-522-1956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-20-46042103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst