Provider Demographics
NPI:1184257107
Name:BUXTON, RICHARD GREGG (LCMHC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:GREGG
Last Name:BUXTON
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:BUXTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCMHC
Mailing Address - Street 1:739 S 300 W UNIT 113
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-2617
Mailing Address - Country:US
Mailing Address - Phone:801-644-8005
Mailing Address - Fax:
Practice Address - Street 1:739 S 300 W UNIT 113
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-2617
Practice Address - Country:US
Practice Address - Phone:801-644-8005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8726983-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health