MEDICARE: GATHER&GROW COUNSELING BY BRYCE DAVIS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1013877364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATHER&GROW COUNSELING BY BRYCE DAVIS, LLC

Provider Business Mailing Address
First Line	:	2624 LAKESIDE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-3309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5100 N BROOKLINE AVE STE 325
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-3609
Country	:	US
Telephone Number	:	580-660-5296
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRYCE DAVIS
Credential	:	LPC
Telephone Number	:	580-660-5296

Provider Enumeration Date	:	11/17/2025
Last Update Date	:	11/17/2025

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