Provider Demographics
NPI:1740075100
Name:FELTON, ANTIONNE JAXON (MA)
Entity type:Individual
Prefix:
First Name:ANTIONNE
Middle Name:JAXON
Last Name:FELTON
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MARIN ST STE 225
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4301
Mailing Address - Country:US
Mailing Address - Phone:805-379-1401
Mailing Address - Fax:
Practice Address - Street 1:501 MARIN ST STE 225
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4301
Practice Address - Country:US
Practice Address - Phone:805-379-1401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician