Healthcare Provider Details

I. General information

NPI: 1184208050
Provider Name (Legal Business Name): PRISCILLA TIXI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 WALDO PL
ENGLEWOOD NJ
07631-2333
US

IV. Provider business mailing address

193 WALDO PL
ENGLEWOOD NJ
07631-2333
US

V. Phone/Fax

Practice location:
  • Phone: 201-212-7844
  • Fax:
Mailing address:
  • Phone: 201-212-7844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC8586
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01067400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: