Provider Demographics
NPI:1972267581
Name:MIXON, JOSEPH JUSTIN
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JUSTIN
Last Name:MIXON
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 1:1730 MAPLESTONE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-1893
Mailing Address - Country:US
Mailing Address - Phone:865-719-3923
Mailing Address - Fax:
Practice Address - Street 1:10414 JACKSON OAKS WAY STE 103
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-0704
Practice Address - Country:US
Practice Address - Phone:865-888-6833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1923106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist