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NPI Code Detail

MEDICARE: CARLY DAVIS

MEDICARE: CARLY 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
1106H00000XMarriage & Family TherapistMN

General Provider Information

NPI Number : 1598628406
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLY DAVIS
Provider Business Mailing Address
First Line : 4712 ZENITH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55410-1872
Country : US
Telephone Number : 612-219-7763
Fax Number :
Provider Business Practice Location Address
First Line : 3112 HENNEPIN AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-2619
Country : US
Telephone Number : 612-293-8814
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2025
Last Update Date : 12/08/2025

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Directions to “ CARLY DAVIS ” Practice Location

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