MEDICARE: MRS. YVETTE ELIZABETH DIXON MFT/IMF

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	106H00000X	Marriage & Family Therapist	44584	CA

General Provider Information

NPI Number	:	1174632228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YVETTE ELIZABETH DIXON MFT/IMF

Provider Business Mailing Address
First Line	:	8751 DOVE TREE LN
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-6791
Country	:	US
Telephone Number	:	916-393-9326
Fax Number	:	916-393-9726

Provider Business Practice Location Address
First Line	:	4612 ROSEVILLE RD
Second Line	:
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-5175
Country	:	US
Telephone Number	:	916-344-0199
Fax Number	:	916-339-3029

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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