Provider Demographics
NPI:1790153559
Name:DIXON-BURNS, CHERYL
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:DIXON-BURNS
Suffix:
Gender:F
Credentials:
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 1824
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86327-1824
Mailing Address - Country:US
Mailing Address - Phone:480-220-2788
Mailing Address - Fax:
Practice Address - Street 1:12420 EAST KACHINA PLACE
Practice Address - Street 2:SUITE 1824
Practice Address - City:DEWEY
Practice Address - State:AZ
Practice Address - Zip Code:86327-1824
Practice Address - Country:US
Practice Address - Phone:480-220-2788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4544103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service