Provider Demographics
NPI:1649537028
Name:BRAXTON, MICHAEL (LCSW,LCDC,MHPS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BRAXTON
Suffix:
Gender:M
Credentials:LCSW,LCDC,MHPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 FIELDFARE DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-1774
Mailing Address - Country:US
Mailing Address - Phone:503-984-2173
Mailing Address - Fax:
Practice Address - Street 1:3712 FIELDFARE DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-1774
Practice Address - Country:US
Practice Address - Phone:503-984-2173
Practice Address - Fax:503-735-0912
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16044101YA0400X
172V00000X, 261QM1300X
TX205-0124175T00000X
ORL151451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty