Provider Demographics
NPI:1568621571
Name:NIXON, WILLIAM RUSSELL JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RUSSELL
Last Name:NIXON
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:300 E MAPLE RD
Mailing Address - Street 2:SUITE 323
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6308
Mailing Address - Country:US
Mailing Address - Phone:248-644-7368
Mailing Address - Fax:248-644-2901
Practice Address - Street 1:300 E MAPLE RD
Practice Address - Street 2:SUITE 323
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6308
Practice Address - Country:US
Practice Address - Phone:248-644-7368
Practice Address - Fax:248-644-2901
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI002567103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
MP0N60160OtherMEDICARE PROVIDER NUMBER
MI0N60160OtherMEDICARE PROVIDER NUMBER