Healthcare Provider Details

I. General information

NPI: 1669145983
Provider Name (Legal Business Name): JENNIFER DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BELMONT AVE
SOMERSET KY
42501-2419
US

IV. Provider business mailing address

200 BELMONT AVE
SOMERSET KY
42501-2419
US

V. Phone/Fax

Practice location:
  • Phone: 606-687-2038
  • Fax: 606-200-3654
Mailing address:
  • Phone: 606-687-2038
  • Fax: 606-200-3654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: