MEDICARE: LINDA J. DAVIS LBSW

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	171M00000X	Case Manager/Care Coordinator	000366	TX

General Provider Information

NPI Number	:	1508153917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA J. DAVIS LBSW

Provider Business Mailing Address
First Line	:	11 LUCAS LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-3408
Country	:	US
Telephone Number	:	817-615-8152
Fax Number	:	817-615-8152

Provider Business Practice Location Address
First Line	:	11 LUCAS LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-3408
Country	:	US
Telephone Number	:	817-615-8152
Fax Number	:	817-615-8152

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

Provider Enumeration Date	:	07/06/2011
Last Update Date	:	07/06/2011

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