Provider Demographics
NPI:1366791279
Name:DIXON, TYANA RENIEKA
Entity type:Individual
Prefix:MRS
First Name:TYANA
Middle Name:RENIEKA
Last Name:DIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TYANA
Other - Middle Name:RENIEKA
Other - Last Name:BELVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4613 MEADOWOAK DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-7022
Mailing Address - Country:US
Mailing Address - Phone:405-474-3935
Mailing Address - Fax:
Practice Address - Street 1:4209 NW 23RD ST STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-2645
Practice Address - Country:US
Practice Address - Phone:405-917-1709
Practice Address - Fax:405-917-1713
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst