Healthcare Provider Details

I. General information

NPI: 1659098499
Provider Name (Legal Business Name): PEYTON BROOKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 W MARCH LN STE 125
STOCKTON CA
95207-8224
US

IV. Provider business mailing address

2495 W MARCH LN STE 125
STOCKTON CA
95207-8224
US

V. Phone/Fax

Practice location:
  • Phone: 209-465-1080
  • Fax: 209-465-2709
Mailing address:
  • Phone: 209-465-1080
  • Fax: 209-465-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberACPP20410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: