Healthcare Provider Details

I. General information

NPI: 1851958748
Provider Name (Legal Business Name): 333 PSYCHOLOGICAL MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2019
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 S BAILEY ST STE 104
PALMER AK
99645-6360
US

IV. Provider business mailing address

634 S BAILEY ST STE 104
PALMER AK
99645-6360
US

V. Phone/Fax

Practice location:
  • Phone: 907-467-3337
  • Fax: 907-746-3336
Mailing address:
  • Phone: 907-467-3337
  • Fax: 907-746-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL G DAVIS
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 907-521-2888