Provider Demographics
NPI:1790315562
Name:HIXSON-WEISS, A ELAINE (MC, LPC)
Entity Type:Individual
Prefix:
First Name:A
Middle Name:ELAINE
Last Name:HIXSON-WEISS
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 E SPEEDWAY BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-4762
Mailing Address - Country:US
Mailing Address - Phone:520-310-9525
Mailing Address - Fax:
Practice Address - Street 1:2230 E SPEEDWAY BLVD STE 120
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-4762
Practice Address - Country:US
Practice Address - Phone:520-310-9525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13031101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional