Provider Demographics
NPI:1013624311
Name:DIXON, JASMINE (LMFTA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 MURRAY FARM DR APT 526
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75069-6910
Mailing Address - Country:US
Mailing Address - Phone:601-951-9569
Mailing Address - Fax:
Practice Address - Street 1:309 MURRAY FARM DR APT 526
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TX
Practice Address - Zip Code:75069-6910
Practice Address - Country:US
Practice Address - Phone:601-951-9569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204120106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist