Peyton Lightning Bolt
Individual provider Active NPI Behavior Analyst · Saint Johns, FL
NPI 1104331768 · NPPES record last updated Dec 5, 2017
Key facts
- NPI
- 1104331768
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- Practice address
- 741 Austin PL
Saint Johns, FL 32259-5472 - Phone
- (386) 846-8407
- NPI assigned
- Dec 5, 2017
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bolt Behavior Services | Behavior Analyst | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | Yes |
Addresses
Primary practice location
741 Austin PL
Saint Johns, FL 32259-5472
Mailing address
741 Austin PL
Saint Johns, FL 32259-5472
Phone (386) 846-8407
Other providers in Saint Johns, FL
- Better Families Counseling, PLLC
- BJ'S Wholesale Club Inc.
- Black Canary Therapy LLC
- Black Sheep Counseling LLC
- Kelsey L. Bloom
- Joseph William Bonura
- Margaret Suzanne Booher
- Tracie Boudreau
- Jessica Bowes
- Kelly Anne Boyer
All providers in Saint Johns, FL · Behavior Analyst in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.