Provider Demographics
NPI:1538697396
Name:DICKSON, JANELL K (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JANELL
Middle Name:K
Last Name:DICKSON
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:PO BOX 7072
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-7072
Mailing Address - Country:US
Mailing Address - Phone:928-657-8000
Mailing Address - Fax:928-657-8009
Practice Address - Street 1:1/4 MILE NE OF BASHAS
Practice Address - Street 2:
Practice Address - City:DILKON
Practice Address - State:AZ
Practice Address - Zip Code:86047
Practice Address - Country:US
Practice Address - Phone:928-657-8000
Practice Address - Fax:928-657-8009
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16517101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health