Provider Demographics
NPI:1003788951
Name:DIXON, TERRY ALLEN
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:ALLEN
Last Name:DIXON
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 1:2556 HUDSON PL
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3748
Mailing Address - Country:US
Mailing Address - Phone:504-957-2216
Mailing Address - Fax:
Practice Address - Street 1:2600 GRAVIER ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7459
Practice Address - Country:US
Practice Address - Phone:504-529-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-20
Last Update Date:2025-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X, 133NN1002X, 171M00000X, 174H00000X
WA106S00000X, 133NN1002X, 171M00000X, 174H00000X
LA133NN1002X, 171400000X, 171M00000X, 174H00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator