Healthcare Provider Details

I. General information

NPI: 1457081259
Provider Name (Legal Business Name): CAMERON PAXTON TLLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 PATIENT CARE DR STE 104
LANSING MI
48911-4292
US

IV. Provider business mailing address

3960 PATIENT CARE DR STE 104
LANSING MI
48911-4292
US

V. Phone/Fax

Practice location:
  • Phone: 517-887-9801
  • Fax:
Mailing address:
  • Phone: 517-887-9801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6362009505
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: