Provider Demographics
NPI:1093379547
Name:HIXON, ELIZABETH HELENA (LCDC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:HELENA
Last Name:HIXON
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S ZARZAMORA ST STE 209
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-5248
Mailing Address - Country:US
Mailing Address - Phone:210-822-9493
Mailing Address - Fax:
Practice Address - Street 1:700 S ZARZAMORA ST STE 209
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5248
Practice Address - Country:US
Practice Address - Phone:210-822-9493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14150101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional