Healthcare Provider Details

I. General information

NPI: 1457286981
Provider Name (Legal Business Name): PEYTON G HOLLAND BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5960 GETWELL RD STE 212D
SOUTHAVEN MS
38672-7320
US

IV. Provider business mailing address

3606 EDGEWOOD BLVD W
HERNANDO MS
38632-9316
US

V. Phone/Fax

Practice location:
  • Phone: 662-228-0130
  • Fax: 678-868-2843
Mailing address:
  • Phone: 662-403-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: