MEDICARE: ROYLETHA LAVERNE DIXON

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	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1194042200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROYLETHA LAVERNE DIXON

Provider Business Mailing Address
First Line	:	8530 DOSKOCIL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-1152
Country	:	US
Telephone Number	:	281-459-4726
Fax Number	:	281-459-4726

Provider Business Practice Location Address
First Line	:	8530 DOSKOCIL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-1152
Country	:	US
Telephone Number	:	281-459-4726
Fax Number	:	281-459-4726

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

Provider Enumeration Date	:	04/28/2010
Last Update Date	:	04/28/2010

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Directions to “ ROYLETHA LAVERNE DIXON ” Practice Location

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