Healthcare Provider Details

I. General information

NPI: 1518263037
Provider Name (Legal Business Name): PHILLIP LEE DAVIS NCC, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N HIGHWAY 1
BIRMINGHAM IA
52535-7700
US

IV. Provider business mailing address

18219 150TH ST
DOUDS IA
52551-8036
US

V. Phone/Fax

Practice location:
  • Phone: 641-455-0636
  • Fax: 319-498-4246
Mailing address:
  • Phone: 641-919-3465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001316
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00116
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: