Provider Demographics
NPI:1770446890
Name:LORTON, MALAYA RENAE
Entity type:Individual
Prefix:
First Name:MALAYA
Middle Name:RENAE
Last Name:LORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 W SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2171
Mailing Address - Country:US
Mailing Address - Phone:765-686-7375
Mailing Address - Fax:
Practice Address - Street 1:2620 ACCUTECH WAY
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-9462
Practice Address - Country:US
Practice Address - Phone:765-282-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-05
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician