Healthcare Provider Details

I. General information

NPI: 1700717188
Provider Name (Legal Business Name): SCOTT DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4851 INDEPENDENCE ST FL 1
WHEAT RIDGE CO
80033-6715
US

IV. Provider business mailing address

1205 YARROW ST
LAKEWOOD CO
80214-4120
US

V. Phone/Fax

Practice location:
  • Phone: 303-717-8794
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: