Provider Demographics
NPI:1104353200
Name:CHOE, PEYTON LEIGH (MED)
Entity type:Individual
Prefix:MRS
First Name:PEYTON
Middle Name:LEIGH
Last Name:CHOE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4680 DOUGLAS CIR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3619
Mailing Address - Country:US
Mailing Address - Phone:330-703-6578
Mailing Address - Fax:
Practice Address - Street 1:4680 DOUGLAS CIR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3619
Practice Address - Country:US
Practice Address - Phone:330-703-6578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2103449101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0444455Medicaid