Healthcare Provider Details

I. General information

NPI: 1316637390
Provider Name (Legal Business Name): AMY LYNN DIXON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY L GAINES BSW

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 TERRY ST STE 320
LONGMONT CO
80501-5490
US

IV. Provider business mailing address

350 TERRY ST STE 320
LONGMONT CO
80501-5490
US

V. Phone/Fax

Practice location:
  • Phone: 970-310-3406
  • Fax: 888-965-4615
Mailing address:
  • Phone: 970-310-3406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09933575
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWC.0000001828
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: