MEDICARE: CRYSTAL DAVIS EDD

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1396553558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL DAVIS EDD

Provider Business Mailing Address
First Line	:	PO BOX 6812
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-0812
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1921 ELM ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-7772
Country	:	US
Telephone Number	:	513-206-2496
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2024
Last Update Date	:	12/20/2024

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Directions to “ CRYSTAL DAVIS EDD” Practice Location

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