Healthcare Provider Details

I. General information

NPI: 1619582418
Provider Name (Legal Business Name): MONICA JEAN DAVIS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 6TH AVE W
BRADENTON FL
34205-8820
US

IV. Provider business mailing address

PO BOX 197515
NASHVILLE TN
37219-7515
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-4150
  • Fax:
Mailing address:
  • Phone: 941-782-4299
  • Fax: 941-782-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH22642
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: