Healthcare Provider Details

I. General information

NPI: 1154863116
Provider Name (Legal Business Name): DAVID MANN NIXON LCSW, DMHP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 NE KRESKY AVE
CHEHALIS WA
98532
US

IV. Provider business mailing address

3285 FERGUSON ST SW
TUMWATER WA
98512-6192
US

V. Phone/Fax

Practice location:
  • Phone: 360-330-9595
  • Fax: 360-330-9560
Mailing address:
  • Phone: 360-943-1907
  • Fax: 360-943-1912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60492662
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: