Healthcare Provider Details

I. General information

NPI: 1356853865
Provider Name (Legal Business Name): SHANNON DENISE NIXSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 READING RD
CINCINNATI OH
45202-1420
US

IV. Provider business mailing address

311 ALBERT SABIN WAY
CINCINNATI OH
45229-2838
US

V. Phone/Fax

Practice location:
  • Phone: 513-651-4142
  • Fax: 513-651-2310
Mailing address:
  • Phone: 513-651-4142
  • Fax: 513-651-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0600697
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: