Healthcare Provider Details

I. General information

NPI: 1568621571
Provider Name (Legal Business Name): WILLIAM RUSSELL NIXON JR. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E MAPLE RD SUITE 323
BIRMINGHAM MI
48009-6308
US

IV. Provider business mailing address

300 E MAPLE RD SUITE 323
BIRMINGHAM MI
48009-6308
US

V. Phone/Fax

Practice location:
  • Phone: 248-644-7368
  • Fax: 248-644-2901
Mailing address:
  • Phone: 248-644-7368
  • Fax: 248-644-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number002567
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: