Provider Demographics
NPI:1942805601
Name:NIXON, MORTON RANDALL
Entity Type:Individual
Prefix:
First Name:MORTON
Middle Name:RANDALL
Last Name:NIXON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 MERIT DR STE 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2291
Mailing Address - Country:US
Mailing Address - Phone:972-701-3626
Mailing Address - Fax:972-701-3609
Practice Address - Street 1:12221 MERIT DR STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2291
Practice Address - Country:US
Practice Address - Phone:972-701-3626
Practice Address - Fax:972-701-3609
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81859101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor