Provider Demographics
NPI:1164019147
Name:DIXON, MALORI PAGE (COUNSELING INTERN)
Entity Type:Individual
Prefix:MS
First Name:MALORI
Middle Name:PAGE
Last Name:DIXON
Suffix:
Gender:F
Credentials:COUNSELING INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-1951
Mailing Address - Country:US
Mailing Address - Phone:801-446-6312
Mailing Address - Fax:
Practice Address - Street 1:3149 E 9800 S
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-4213
Practice Address - Country:US
Practice Address - Phone:801-746-9909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-24
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health