Healthcare Provider Details

I. General information

NPI: 1477045102
Provider Name (Legal Business Name): DAVID LAMONT LAXTON IV LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 E AIRPORT AVE
BATON ROUGE LA
70806-6517
US

IV. Provider business mailing address

673 E AIRPORT AVE
BATON ROUGE LA
70806-6517
US

V. Phone/Fax

Practice location:
  • Phone: 225-300-8788
  • Fax: 225-308-8301
Mailing address:
  • Phone: 225-300-8788
  • Fax: 225-308-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6522
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: