MEDICARE: HALLIE A 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
1	101YM0800X	Mental Health Counselor	C.2506746

General Provider Information

NPI Number	:	1538971676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALLIE A DAVIS

Provider Business Mailing Address
First Line	:	960 GRAHAM RD
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-1155
Country	:	US
Telephone Number	:	330-606-9262
Fax Number	:

Provider Business Practice Location Address
First Line	:	3757 FISHCREEK RD
Second Line	:
City	:	STOW
State	:	OH
Zip	:	44224-5404
Country	:	US
Telephone Number	:	330-606-9262
Fax Number	:

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

Provider Enumeration Date	:	01/24/2025
Last Update Date	:	01/24/2025

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