MEDICARE: KAYCIE 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	27103	FL

General Provider Information

NPI Number	:	1659234409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYCIE DAVIS

Provider Business Mailing Address
First Line	:	303 CITY VIEW DR
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-9160
Country	:	US
Telephone Number	:	954-228-6879
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 CITY VIEW DR
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-9160
Country	:	US
Telephone Number	:	954-228-6879
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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