Provider Demographics
NPI:1730070806
Name:NIX, MICHAEL SHAWN (LCADC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHAWN
Last Name:NIX
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 GORMAN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-2315
Mailing Address - Country:US
Mailing Address - Phone:606-439-2361
Mailing Address - Fax:606-854-4414
Practice Address - Street 1:45 CENTER ST
Practice Address - Street 2:
Practice Address - City:BEATTYVILLE
Practice Address - State:KY
Practice Address - Zip Code:41311-9052
Practice Address - Country:US
Practice Address - Phone:606-854-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY276411101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)