Provider Demographics
NPI:1003680778
Name:DIXON, MEGAN KATHLEEN (PLPC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:KATHLEEN
Last Name:DIXON
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHRISTINA DR
Mailing Address - Street 2:
Mailing Address - City:PEVELY
Mailing Address - State:MO
Mailing Address - Zip Code:63070-1643
Mailing Address - Country:US
Mailing Address - Phone:636-448-6632
Mailing Address - Fax:
Practice Address - Street 1:12312 MO-21
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:MO
Practice Address - Zip Code:63020
Practice Address - Country:US
Practice Address - Phone:636-249-9993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023045273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health