Provider Demographics
NPI:1568095545
Name:DIXON, TELISA (LCSW)
Entity type:Individual
Prefix:
First Name:TELISA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8102 FRY RD.
Mailing Address - Street 2:STE. A #3047
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-7077
Mailing Address - Country:US
Mailing Address - Phone:214-306-9416
Mailing Address - Fax:
Practice Address - Street 1:8102 FRY RD.
Practice Address - Street 2:STE. A #3047
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-7077
Practice Address - Country:US
Practice Address - Phone:214-306-9416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0281011041C0700X
TX1060681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical