MEDICARE: MR. CHARLES CLIFTON PAXTON JR. MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		CA

General Provider Information

NPI Number	:	1588792352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES CLIFTON PAXTON JR. MSW

Provider Business Mailing Address
First Line	:	855 N ORANGE GROVE BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-3333
Country	:	US
Telephone Number	:	626-796-3453
Fax Number	:	626-744-3411

Provider Business Practice Location Address
First Line	:	855 N ORANGE GROVE BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-3333
Country	:	US
Telephone Number	:	626-796-3453
Fax Number	:	626-744-3411

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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