Active NPI
Lekisha Mixon, PSYD
- Clinical Psychologist
- Oakland, CA
National Provider Identifier
1609422674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY30979
- Practice address
- 400 29TH St Ste 405
Oakland, CA 94609-3549 - Phone
- (510) 268-8544
- NPI assigned
- Aug 14, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Forensic Psychologist | 103TF0200X | PSY30979 | CA | |
| Clinical Psychologist | 103TC0700X | PSY30979 | CA | Primary |
Addresses
Primary practice location
400 29TH St Ste 405
Oakland, CA 94609-3549
Mailing address
1167 Bush St Apt 607
San Francisco, CA 94109-5904
Phone (305) 205-0530
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY30979 | CA | MD | Forensic Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565740800000",
"number": "1609422674",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1167 BUSH ST APT 607",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941095904",
"telephone_number": "305-205-0530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 29TH ST STE 405",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946093549",
"telephone_number": "510-268-8544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIXON",
"first_name": "LEKISHA",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-14",
"last_updated": "2019-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "CA",
"license": "PSY30979",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY30979",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.