Individual
JACOB TYLER DIXON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BSW TCM
Contact information
Practice address
1726 CARCASSONNE RD, BLACKEY, KY 41804-9066
(606) 335-0185
Mailing address
1726 CARCASSONNE RD, BLACKEY, KY 41804-9066
(606) 335-0185
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
KY
Other
Enumeration date
12/10/2024
Last updated
12/10/2024
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