MEDICARE: PHYLLIS DAVENPORT

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

General Provider Information

NPI Number	:	1861850448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS DAVENPORT

Provider Business Mailing Address
First Line	:	9236 SNOWBERRY DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73165-9730
Country	:	US
Telephone Number	:	405-601-5011
Fax Number	:

Provider Business Practice Location Address
First Line	:	9236 SNOWBERRY DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73165-9730
Country	:	US
Telephone Number	:	405-601-5011
Fax Number	:

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

Provider Enumeration Date	:	02/10/2016
Last Update Date	:	02/10/2016

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Directions to “ PHYLLIS DAVENPORT ” Practice Location

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