Provider Demographics
NPI:1629184981
Name:DIXON, WILLIAM KEVIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KEVIN
Last Name:DIXON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 S COLORADO BLVD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-8008
Mailing Address - Country:US
Mailing Address - Phone:303-777-8617
Mailing Address - Fax:720-570-2326
Practice Address - Street 1:695 S COLORADO BLVD
Practice Address - Street 2:SUITE 420
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-8008
Practice Address - Country:US
Practice Address - Phone:303-777-8617
Practice Address - Fax:720-570-2326
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO864103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC97746Medicare PIN