Provider Demographics
NPI:1952685026
Name:DIXON, EMILY ANN (PSYD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:DIXON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N ROARING SPRINGS RD APT 9306
Mailing Address - Street 2:
Mailing Address - City:WESTWORTH VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76114-3559
Mailing Address - Country:US
Mailing Address - Phone:949-562-8933
Mailing Address - Fax:
Practice Address - Street 1:101 N ROARING SPRINGS RD APT 9306
Practice Address - Street 2:
Practice Address - City:WESTWORTH VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:76114-3559
Practice Address - Country:US
Practice Address - Phone:949-562-8933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX38658103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952685026OtherPSYCHOLOGY