Provider Demographics
NPI:1255964946
Name:PAXTON, JEREMY CLARK
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:CLARK
Last Name:PAXTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 NORTH LOOP W STE 940
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-5602
Mailing Address - Country:US
Mailing Address - Phone:281-630-6848
Mailing Address - Fax:713-338-2371
Practice Address - Street 1:1415 NORTH LOOP W STE 940
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-5602
Practice Address - Country:US
Practice Address - Phone:832-940-2352
Practice Address - Fax:713-338-2371
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202690106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist