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NPI Code Detail

MEDICARE: TYSON DAVIS

MEDICARE: TYSON DAVIS
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
1103TC0700XClinical Psychologist38201TX
2103TC0700XClinical PsychologistPS017720PA

General Provider Information

NPI Number : 1417205774
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYSON DAVIS
Provider Business Mailing Address
First Line : 1515 S CAPITAL OF TEXAS HWY
Second Line : STE 200
City : AUSTIN
State : TX
Zip : 78746-6544
Country : US
Telephone Number : 512-767-1136
Fax Number :
Provider Business Practice Location Address
First Line : 1515 S CAPITAL OF TEXAS HWY
Second Line : STE 200
City : AUSTIN
State : TX
Zip : 78746-6544
Country : US
Telephone Number : 512-767-1136
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2012
Last Update Date : 02/18/2020

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Directions to “ TYSON DAVIS ” Practice Location

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