Provider Demographics
NPI:1356957492
Name:CLAXTON, LATOYA K
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:K
Last Name:CLAXTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19046 BRUCE B DOWNS BLVD BLDG 1509
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2434
Mailing Address - Country:US
Mailing Address - Phone:813-563-2775
Mailing Address - Fax:
Practice Address - Street 1:19046 BRUCE B DOWNS BLVD BLDG 1509
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2434
Practice Address - Country:US
Practice Address - Phone:813-563-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13284101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health