Provider Demographics
NPI:1184843609
Name:DIXON, BETTY (MA, BHRS, CCMA)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:MA, BHRS, CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-0250
Mailing Address - Country:US
Mailing Address - Phone:580-326-7531
Mailing Address - Fax:580-326-2377
Practice Address - Street 1:HC 79 BOX 411
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-9320
Practice Address - Country:US
Practice Address - Phone:580-326-7531
Practice Address - Fax:580-326-2377
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health