Provider Demographics
NPI:1457081259
Name:PAXTON, CAMERON (TLLP)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:PAXTON
Suffix:
Gender:M
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 PATIENT CARE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4292
Mailing Address - Country:US
Mailing Address - Phone:517-887-9801
Mailing Address - Fax:
Practice Address - Street 1:3960 PATIENT CARE DR STE 104
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4292
Practice Address - Country:US
Practice Address - Phone:517-887-9801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009505103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist