Provider Demographics
NPI:1356685408
Name:BUXTON, MICHAEL S (PHD, MFT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:BUXTON
Suffix:
Gender:M
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E 4500 S
Mailing Address - Street 2:D-140
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2929
Mailing Address - Country:US
Mailing Address - Phone:801-288-0747
Mailing Address - Fax:801-288-0761
Practice Address - Street 1:1500 WSC
Practice Address - Street 2:BYU
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84602-7924
Practice Address - Country:US
Practice Address - Phone:801-318-1900
Practice Address - Fax:801-422-0173
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT360148-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist