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General NPI Number Information
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NPI Number | 1497843866
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Entity Type | Individual
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Provider Name | H LARA BRAXTON PHD
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Gender | Female
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 10/12/2008
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Provider Practice Location Address
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Address Line | 7760 OLENTANGY RIVER ROAD SUITE 105
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City | COLUMBUS
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State | OH
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Zip | 43235-1332
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Country | US
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Telephone | 614-848-3310
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Fax | 614-848-3516
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Provider Business Mailing Address
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Address Line | 7760 OLENTANGY RIVER ROAD SUITE 105
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City | COLUMBUS
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State | OH
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Zip | 43235-1332
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Country | US
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Telephone | 614-848-3310
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Fax | 614-848-3516
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4740
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License Number State | OH
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