Healthcare Provider Details

I. General information

NPI: 1023385077
Provider Name (Legal Business Name): TAWNYA RENEE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 10/09/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 EMERSON AVE
BONNER SPRINGS KS
66012-1904
US

IV. Provider business mailing address

126 ELM ST
BONNER SPRINGS KS
66012-1021
US

V. Phone/Fax

Practice location:
  • Phone: 913-543-1150
  • Fax:
Mailing address:
  • Phone: 541-221-8262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number03702
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC7078
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: