Healthcare Provider Details

I. General information

NPI: 1619294014
Provider Name (Legal Business Name): RICHARD FREDRICK DAVIS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RICK DAVIS

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 W SANETTA ST
NAMPA ID
83651-5047
US

IV. Provider business mailing address

9612 GOLDEN WILLOW ST
MIDDLETON ID
83644-5287
US

V. Phone/Fax

Practice location:
  • Phone: 208-466-7443
  • Fax: 208-466-7443
Mailing address:
  • Phone: 208-585-2707
  • Fax: 208-585-2707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: