Provider Demographics
NPI:1437674611
Name:DYKES, DENVER ELAINE (MA, LPC, LCDC-I)
Entity Type:Individual
Prefix:MISS
First Name:DENVER
Middle Name:ELAINE
Last Name:DYKES
Suffix:
Gender:F
Credentials:MA, LPC, LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5567
Mailing Address - Country:US
Mailing Address - Phone:903-576-0089
Mailing Address - Fax:
Practice Address - Street 1:1300 N 6TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604
Practice Address - Country:US
Practice Address - Phone:903-576-0089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72948101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional