Provider Demographics
NPI:1659840361
Name:NIXON, JESSICA MONIQUE (LMHC, LPCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MONIQUE
Last Name:NIXON
Suffix:
Gender:F
Credentials:LMHC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 SW 24TH TER
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-6037
Mailing Address - Country:US
Mailing Address - Phone:561-350-6601
Mailing Address - Fax:
Practice Address - Street 1:4895 WINDWARD PASSAGE DR STE 6
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-7741
Practice Address - Country:US
Practice Address - Phone:561-877-8753
Practice Address - Fax:561-877-8759
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH83-1529261324500000X
FL47-1172948324500000X
FLMH14675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility