Healthcare Provider Details

I. General information

NPI: 1356677934
Provider Name (Legal Business Name): GINA LYNN DIXON M.ED.,LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 24TH AVE NW
NORMAN OK
73069-6369
US

IV. Provider business mailing address

4515 CHUKKAR CT
NORMAN OK
73072-3121
US

V. Phone/Fax

Practice location:
  • Phone: 405-919-1817
  • Fax:
Mailing address:
  • Phone: 405-919-1817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5274
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: