Healthcare Provider Details

I. General information

NPI: 1861950453
Provider Name (Legal Business Name): MARIO DIXON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9725 SW BEAVERTON HILLSDALE HWY STE 310
BEAVERTON OR
97005-3366
US

IV. Provider business mailing address

9725 SW BEAVERTON HILLSDALE HWY STE 310
BEAVERTON OR
97005-3366
US

V. Phone/Fax

Practice location:
  • Phone: 503-376-9520
  • Fax: 971-223-0903
Mailing address:
  • Phone: 503-376-9520
  • Fax: 971-223-0903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: