MEDICARE: THE DAVIS GROUP COUNSELING AND WELLNESS SERVICES

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1255091286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DAVIS GROUP COUNSELING AND WELLNESS SERVICES

Provider Business Mailing Address
First Line	:	1380 LEAD HILL BLVD STE 160
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-2998
Country	:	US
Telephone Number	:	916-740-6424
Fax Number	:

Provider Business Practice Location Address
First Line	:	1380 LEAD HILL BLVD STE 160
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-2998
Country	:	US
Telephone Number	:	916-740-6424
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND DIRECTOR
Name	:	DR. SEAN DAVIS
Credential	:	PHD
Telephone Number	:	916-844-4615

Provider Enumeration Date	:	12/17/2021
Last Update Date	:	12/17/2021

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