Provider Demographics
NPI:1619953916
Name:DIXON, DAVID V (LCPC LMFT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:V
Last Name:DIXON
Suffix:
Gender:M
Credentials:LCPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 KIMBERLY RD
Mailing Address - Street 2:SUITE 7B
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-7881
Mailing Address - Country:US
Mailing Address - Phone:208-736-1636
Mailing Address - Fax:208-735-1656
Practice Address - Street 1:1300 KIMBERLY RD
Practice Address - Street 2:SUITE 7B
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-7881
Practice Address - Country:US
Practice Address - Phone:208-736-1636
Practice Address - Fax:208-735-1656
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC2990101Y00000X
IDLMFT2991101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor