MEDICARE: E. CLIFTON DAVIS, ED.D., & ASSOCIATES, P.C.

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	103T00000X	Psychologist	2-2012	TX
2	106H00000X	Marriage & Family Therapist	2-2012	TX
3	103TC2200X	Clinical Child & Adolescent Psychologist	2-2012	TX
4	103TC0700X	Clinical Psychologist	2-2012	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2-2012	OTHER	TX	TEXAS PSYCHOLOGY LICENSE

General Provider Information

NPI Number	:	1538157318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E. CLIFTON DAVIS, ED.D., & ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	17304 PRESTON RD
Second Line	:	SUITE 800
City	:	DALLAS
State	:	TX
Zip	:	75252-5618
Country	:	US
Telephone Number	:	214-438-3668
Fax Number	:	972-733-6812

Provider Business Practice Location Address
First Line	:	17304 PRESTON RD
Second Line	:	SUITE 800
City	:	DALLAS
State	:	TX
Zip	:	75252-5618
Country	:	US
Telephone Number	:	214-438-3668
Fax Number	:	972-733-6812

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. EDWARD CLIFTON DAVIS
Credential	:	ED.D.
Telephone Number	:	214-438-3668

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	08/06/2008

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Practice Fax: 972-733-6812

Directions to “E. CLIFTON DAVIS, ED.D., & ASSOCIATES, P.C. ” Practice Location

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