Provider Demographics
NPI:1922685676
Name:NIX, TIA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:NIX
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 W 62ND PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2932
Mailing Address - Country:US
Mailing Address - Phone:773-367-9512
Mailing Address - Fax:
Practice Address - Street 1:1008 W 62ND PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2932
Practice Address - Country:US
Practice Address - Phone:773-367-9512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical