Healthcare Provider Details

I. General information

NPI: 1174427926
Provider Name (Legal Business Name): TRISHA NIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59397 COUNTY ROAD 11
ELKHART IN
46517-9733
US

IV. Provider business mailing address

59397 COUNTY ROAD 11
ELKHART IN
46517-9733
US

V. Phone/Fax

Practice location:
  • Phone: 574-830-7269
  • Fax:
Mailing address:
  • Phone: 574-830-7269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001800A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number10140085
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: