Provider Demographics
NPI:1356677934
Name:DIXON, GINA LYNN (MED,LPC)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:LYNN
Last Name:DIXON
Suffix:
Gender:F
Credentials:MED,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 PROSPECT CT
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-2911
Mailing Address - Country:US
Mailing Address - Phone:405-919-1817
Mailing Address - Fax:
Practice Address - Street 1:2212 WESTPARK DR STE 105
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4098
Practice Address - Country:US
Practice Address - Phone:405-919-1817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X
OK5274101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool