Healthcare Provider Details

I. General information

NPI: 1992922728
Provider Name (Legal Business Name): MELINDA DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W 10TH ST
AUSTIN TX
78703-3907
US

IV. Provider business mailing address

4424 GAINES RANCH LOOP APT. 820
AUSTIN TX
78735-6492
US

V. Phone/Fax

Practice location:
  • Phone: 512-804-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number202424
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: