Provider Demographics
NPI:1003167198
Name:NIXON, SEAN J (LCPC, LMFT, NCC)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:J
Last Name:NIXON
Suffix:
Gender:M
Credentials:LCPC, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 W TROPICAL DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-8744
Mailing Address - Country:US
Mailing Address - Phone:208-869-4520
Mailing Address - Fax:
Practice Address - Street 1:1655 W FAIRVIEW AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5100
Practice Address - Country:US
Practice Address - Phone:208-515-7661
Practice Address - Fax:208-515-7661
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLAMFT-4954106H00000X
IDLPC-5100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist