MEDICARE: MRS. VERLISA DIXON-GREEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	373H00000X	Day Training/Habilitation Specialist		TX

General Provider Information

NPI Number	:	1154292845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VERLISA DIXON-GREEN

Provider Business Mailing Address
First Line	:	3741 FAIRHAVEN DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-1317
Country	:	US
Telephone Number	:	817-600-5752
Fax Number	:

Provider Business Practice Location Address
First Line	:	3741 FAIRHAVEN DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-1317
Country	:	US
Telephone Number	:	817-600-5752
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2025
Last Update Date	:	09/15/2025

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Directions to “ MRS. VERLISA DIXON-GREEN ” Practice Location

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