=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225740731
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MISS TRESSLYN CLARICE NIXON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2022
-----------------------------------------------------
Last Update Date | 12/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8542 SIEGEN LN STE 6
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70810-1940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-361-9576
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8542 SIEGEN LN STE 6
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70810-1940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-361-9576
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | PLM1527
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------