Healthcare Provider Details

I. General information

NPI: 1235591017
Provider Name (Legal Business Name): LAURA PAXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 CENTRAL AVE
BETTENDORF IA
52722-5143
US

IV. Provider business mailing address

3302 CENTRAL AVE
BETTENDORF IA
52722-5143
US

V. Phone/Fax

Practice location:
  • Phone: 757-350-1621
  • Fax:
Mailing address:
  • Phone: 757-350-1621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: