Healthcare Provider Details

I. General information

NPI: 1093645871
Provider Name (Legal Business Name): ALEXANDRIA DAVIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 N LAKEVIEW DR
DERBY KS
67037-2941
US

IV. Provider business mailing address

1325 N LAKEVIEW DR
DERBY KS
67037-2941
US

V. Phone/Fax

Practice location:
  • Phone: 316-737-5936
  • Fax: 316-737-5936
Mailing address:
  • Phone: 316-737-5936
  • Fax: 316-737-5936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRIA DAVIS
Title or Position: THERAPIST
Credential: LCMFT
Phone: 316-737-5936