Healthcare Provider Details

I. General information

NPI: 1083425409
Provider Name (Legal Business Name): MK DIXON COUNSELING & CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 RUE BEAUREGARD STE F
LAFAYETTE LA
70508-8511
US

IV. Provider business mailing address

75 MAIN ST
FRANKLIN LA
70538-7026
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-0254
  • Fax:
Mailing address:
  • Phone: 337-534-0254
  • Fax: 337-534-0542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KIZZY DIXON
Title or Position: ADMINISTRATOR
Credential: PHD
Phone: 337-534-0254