Provider Demographics
NPI:1124697511
Name:DIXON-NEAL, JESSICA TARA (LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:TARA
Last Name:DIXON-NEAL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:DIXON-NEAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1450 STONE CREST DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6605
Mailing Address - Country:US
Mailing Address - Phone:918-734-7797
Mailing Address - Fax:
Practice Address - Street 1:505 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:OK
Practice Address - Zip Code:74454-1015
Practice Address - Country:US
Practice Address - Phone:918-483-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10393101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional