Provider Demographics
NPI:1104272244
Name:DIXON, HARRY J (MA, LMHC, LPCC)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:J
Last Name:DIXON
Suffix:
Gender:M
Credentials:MA, LMHC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 CLEVELAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3301
Mailing Address - Country:US
Mailing Address - Phone:425-296-9793
Mailing Address - Fax:
Practice Address - Street 1:506 2ND AVE
Practice Address - Street 2:SUITE 1417
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2343
Practice Address - Country:US
Practice Address - Phone:425-296-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-08
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60684311101YM0800X
CALPCC4340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty