Provider Demographics
NPI:1831545276
Name:HIXON, TYRA (LISW-S)
Entity type:Individual
Prefix:MRS
First Name:TYRA
Middle Name:
Last Name:HIXON
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-1655
Mailing Address - Country:US
Mailing Address - Phone:740-622-0033
Mailing Address - Fax:740-622-0210
Practice Address - Street 1:610 WALNUT ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1655
Practice Address - Country:US
Practice Address - Phone:740-622-0033
Practice Address - Fax:740-622-0210
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021284101YA0400X
OHI.00316411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)