Provider Demographics
NPI:1316637390
Name:DIXON, AMY LYNN (BSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:DIXON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:GAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:732 S PRATT PKWY
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6409
Mailing Address - Country:US
Mailing Address - Phone:720-899-9267
Mailing Address - Fax:
Practice Address - Street 1:732 S PRATT PKWY
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6409
Practice Address - Country:US
Practice Address - Phone:720-899-9267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSWC.0000001828101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health