Provider Demographics
NPI:1124774971
Name:DIXON, BROOKE T (BLS)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:T
Last Name:DIXON
Suffix:
Gender:F
Credentials:BLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 SPOOL LN SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-5499
Mailing Address - Country:US
Mailing Address - Phone:805-276-2190
Mailing Address - Fax:
Practice Address - Street 1:3243 SPOOL LN SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-5499
Practice Address - Country:US
Practice Address - Phone:805-276-2190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician