Provider Demographics
NPI:1285343152
Name:BRAXTON, LAVERNE (MS)
Entity type:Individual
Prefix:
First Name:LAVERNE
Middle Name:
Last Name:BRAXTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 EAST NANCY LANE
Mailing Address - Street 2:2320 EAST BASELINE RD #195-148
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042
Mailing Address - Country:US
Mailing Address - Phone:602-268-0426
Mailing Address - Fax:602-268-0909
Practice Address - Street 1:1835 EAST NANCY LANE
Practice Address - Street 2:2320 EAST BASELINE RD #195-148
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042
Practice Address - Country:US
Practice Address - Phone:602-268-0426
Practice Address - Fax:602-268-0909
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health