Provider Demographics
NPI:1861847642
Name:DIX, TANYA
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:DIX
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 1:5400 RHODES AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3918
Mailing Address - Country:US
Mailing Address - Phone:504-858-0692
Mailing Address - Fax:504-362-4119
Practice Address - Street 1:5400 RHODES AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-3918
Practice Address - Country:US
Practice Address - Phone:504-858-0692
Practice Address - Fax:504-362-4119
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health