Provider Demographics
NPI:1174354765
Name:CROAKER, PEYTON MARIE (PCLC, LAC)
Entity type:Individual
Prefix:MISS
First Name:PEYTON
Middle Name:MARIE
Last Name:CROAKER
Suffix:
Gender:F
Credentials:PCLC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 TERRY AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-5441
Mailing Address - Country:US
Mailing Address - Phone:406-855-0922
Mailing Address - Fax:
Practice Address - Street 1:12 AVANTA WAY STE 2
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6921
Practice Address - Country:US
Practice Address - Phone:406-272-6228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-71067101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health