Provider Demographics
NPI:1255771994
Name:CROXTON, GREGORY I
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:CROXTON
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:
Other - Last Name:CROXTON
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:DR CROXTON
Mailing Address - Street 1:2525 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-7361
Mailing Address - Country:US
Mailing Address - Phone:810-234-6106
Mailing Address - Fax:
Practice Address - Street 1:100 S JEFFERSON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48607-1267
Practice Address - Country:US
Practice Address - Phone:989-725-6629
Practice Address - Fax:989-752-0895
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008573101YM0800X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst