1740218700 NPI number — MRS. ANDREA LOUISE DIXON MA, LPC

Table of content: MRS. ANDREA LOUISE DIXON MA, LPC (NPI 1740218700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740218700 NPI number — MRS. ANDREA LOUISE DIXON MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIXON
Provider First Name:
ANDREA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740218700
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4422 NE HOIT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEES SUMMIT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64064-1558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-875-0276
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 NE MISSOURI RD
Provider Second Line Business Practice Location Address:
SUITE 276
Provider Business Practice Location Address City Name:
LEES SUMMIT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64086-4722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-875-0276
Provider Business Practice Location Address Fax Number:
816-251-5499
Provider Enumeration Date:
06/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 2008009702 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2008009702 . This is a "DIVISION OF PROFESSIONAL REGISTRATION FOR LICENSED PROFESSIONAL COUNSELOR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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