Provider Demographics
NPI:1477284396
Name:NIXON, DANIEL MICHAEL I
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MICHAEL
Last Name:NIXON
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5338 E EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1918
Mailing Address - Country:US
Mailing Address - Phone:562-844-0174
Mailing Address - Fax:
Practice Address - Street 1:69 ARROWHEAD LOOP
Practice Address - Street 2:
Practice Address - City:CANADIAN
Practice Address - State:OK
Practice Address - Zip Code:74425-5012
Practice Address - Country:US
Practice Address - Phone:562-844-0174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty