Basic Information
| Provider Information | |||||||||
| NPI: | 1831769934 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEYTON | ||||||||
| FirstName: | BRIDGET | ||||||||
| MiddleName: | |||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4880 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930037783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056587827 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6101 W CENTINELA AVE STE 380 | ||||||||
| Address2: | |||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902306367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103377827 | ||||||||
| FaxNumber: | 3103377840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2021 | ||||||||
| LastUpdateDate: | 06/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.