MEDICARE: JOANNE L. DAVIS, PHD 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1528781358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOANNE L. DAVIS, PHD LLC

Provider Business Mailing Address
First Line	:	1724 S 75TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74112-7720
Country	:	US
Telephone Number	:	918-510-7502
Fax Number	:

Provider Business Practice Location Address
First Line	:	1724 S 75TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74112-7720
Country	:	US
Telephone Number	:	918-510-7502
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. JOANNE L DAVIS
Credential	:	PHD
Telephone Number	:	918-510-7502

Provider Enumeration Date	:	09/26/2022
Last Update Date	:	09/26/2022

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