Provider Demographics
NPI:1710226592
Name:FLOYD D DIX
Entity Type:Organization
Organization Name:FLOYD D DIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIX
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:812-345-1087
Mailing Address - Street 1:2512 COVINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1404
Mailing Address - Country:US
Mailing Address - Phone:765-497-3932
Mailing Address - Fax:765-807-0225
Practice Address - Street 1:2512 COVINGTON ST
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1404
Practice Address - Country:US
Practice Address - Phone:765-497-3932
Practice Address - Fax:765-807-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001107A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty