Provider Demographics
NPI:1336258250
Name:MICHAEL J BUXTON & ASSOCIATES P.C.
Entity Type:Organization
Organization Name:MICHAEL J BUXTON & ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BUXTON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:757-490-2666
Mailing Address - Street 1:PO BOX 68123
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23471-8123
Mailing Address - Country:US
Mailing Address - Phone:757-490-2666
Mailing Address - Fax:757-552-0089
Practice Address - Street 1:1020 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5500
Practice Address - Country:US
Practice Address - Phone:757-490-2666
Practice Address - Fax:757-552-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103TC0700X, 261QM0801X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
031204OtherCHAMPUS
092778OtherBLUE CROSS BLUE SHIELD
VA007758626Medicaid
031204OtherCHAMPUS
092778OtherBLUE CROSS BLUE SHIELD