Healthcare Provider Details

I. General information

NPI: 1174332092
Provider Name (Legal Business Name): PEYTON HUTCHINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N ILLINOIS ST STE 1600
INDIANAPOLIS IN
46204-4218
US

IV. Provider business mailing address

311 BOULEVARD OF AMERICAS STE 304
LAKEWOOD NJ
08701-4960
US

V. Phone/Fax

Practice location:
  • Phone: 732-806-0091
  • Fax:
Mailing address:
  • Phone: 402-252-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-182918
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-16177
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: