Healthcare Provider Details

I. General information

NPI: 1144137605
Provider Name (Legal Business Name): PAXTON INDEPENDENT CONTRACTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 CHICAGO AVE
LANSING MI
48915-2106
US

IV. Provider business mailing address

47610 GRAND RIVER AVE # 1040
NOVI MI
48374-1217
US

V. Phone/Fax

Practice location:
  • Phone: 947-223-1500
  • Fax:
Mailing address:
  • Phone: 947-223-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: CAMERON PAXTON
Title or Position: OWNER/CEO
Credential:
Phone: 947-223-1500