Provider Demographics
NPI:1912096355
Name:DIXON, JEANETTE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7818 HAWK TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-4712
Mailing Address - Country:US
Mailing Address - Phone:210-767-8704
Mailing Address - Fax:210-767-8704
Practice Address - Street 1:7818 HAWK TRL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-4712
Practice Address - Country:US
Practice Address - Phone:210-767-8704
Practice Address - Fax:210-767-8704
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12847101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095821703Medicaid