Provider Demographics
NPI:1225304264
Name:DIXON, MISTY DAWN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:DAWN
Last Name:DIXON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 SE BAYBERRY LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-4385
Mailing Address - Country:US
Mailing Address - Phone:816-599-3918
Mailing Address - Fax:816-599-3918
Practice Address - Street 1:684 SE BAYBERRY LN
Practice Address - Street 2:SUITE 103
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4385
Practice Address - Country:US
Practice Address - Phone:816-599-3918
Practice Address - Fax:816-599-3918
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110107461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical