Provider Demographics
NPI:1326359027
Name:DIXON, JEAN TABITHA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:TABITHA
Last Name:DIXON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17101 KUYKENDAHL RD
Mailing Address - Street 2:100 (N)
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-1637
Mailing Address - Country:US
Mailing Address - Phone:281-520-0707
Mailing Address - Fax:
Practice Address - Street 1:17101 KUYKENDAHL RD
Practice Address - Street 2:100 (N)
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-1637
Practice Address - Country:US
Practice Address - Phone:281-520-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63580101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional