MEDICARE: EMILY ANN DIXON PSY.D.

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	103T00000X	Psychologist	38658	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1952685026	OTHER	CA	PSYCHOLOGY

General Provider Information

NPI Number	:	1952685026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ANN DIXON PSY.D.

Provider Business Mailing Address
First Line	:	101 N ROARING SPRINGS RD APT 9306
Second Line	:
City	:	WESTWORTH VILLAGE
State	:	TX
Zip	:	76114-3559
Country	:	US
Telephone Number	:	949-562-8933
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 N ROARING SPRINGS RD APT 9306
Second Line	:
City	:	WESTWORTH VILLAGE
State	:	TX
Zip	:	76114-3559
Country	:	US
Telephone Number	:	949-562-8933
Fax Number	:

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

Provider Enumeration Date	:	10/06/2011
Last Update Date	:	03/19/2021

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