Healthcare Provider Details

I. General information

NPI: 1881818789
Provider Name (Legal Business Name): TINA RENE DAVIS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 E 23RD ST
LAWRENCE KS
66046-5017
US

IV. Provider business mailing address

1739 E 23RD ST
LAWRENCE KS
66046-5017
US

V. Phone/Fax

Practice location:
  • Phone: 785-841-4138
  • Fax: 785-841-5777
Mailing address:
  • Phone: 785-841-4138
  • Fax: 785-841-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number256
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: