Provider Demographics
NPI:1073666046
Name:VALDEZ, DIXIE (MSLPC)
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:MSLPC
Other - Prefix:
Other - First Name:DIXIE
Other - Middle Name:DAWN
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:317 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-5566
Mailing Address - Country:US
Mailing Address - Phone:830-775-3171
Mailing Address - Fax:830-775-4236
Practice Address - Street 1:317 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-5566
Practice Address - Country:US
Practice Address - Phone:830-775-3171
Practice Address - Fax:830-775-4236
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15459101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15459OtherLPC LICENSE NUMBER
TX6520LCOtherBCBS PROVIDER NUMBER