Provider Demographics
NPI:1871605584
Name:DIXON, STACY LYNN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LYNN
Last Name:DIXON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 S LYNCREST AVE. STE 103
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2575
Mailing Address - Country:US
Mailing Address - Phone:605-413-7179
Mailing Address - Fax:605-496-7641
Practice Address - Street 1:6116 S LYNCREST AVE. STE 103
Practice Address - Street 2:SUITE 103
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2575
Practice Address - Country:US
Practice Address - Phone:605-413-7179
Practice Address - Fax:605-496-7641
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1196106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist