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General NPI Number Information
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NPI Number | 1790153559
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Entity Type | Individual
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Provider Name | CHERYL DIXON-BURNS
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Gender | Female
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Dates
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Enumeration Date | 09/10/2015
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Last Update Date | 09/10/2015
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Provider Practice Location Address
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Address Line | 12420 EAST KACHINA PLACE SUITE 1824
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City | DEWEY
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State | AZ
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Zip | 86327-1824
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Country | US
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Telephone | 480-220-2788
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1824
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City | DEWEY
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State | AZ
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Zip | 86327-1824
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Country | US
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Telephone | 480-220-2788
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | BH4544
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License Number State | AZ
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