MEDICARE: JASMINE DIXON LMHC

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	390200000X	Student in an Organized Health Care Education/Training Program
2	101YM0800X	Mental Health Counselor	39004153A	IN

General Provider Information

NPI Number	:	1164927612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE DIXON LMHC

Provider Business Mailing Address
First Line	:	1700 ANDREW AVE APT 3B
Second Line	:
City	:	LA PORTE
State	:	IN
Zip	:	46350-5356
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 INDIAN BOUNDARY RD
Second Line	:
City	:	CHESTERTON
State	:	IN
Zip	:	46304-1511
Country	:	US
Telephone Number	:	888-883-8433
Fax Number	:

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

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	01/04/2023

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