Healthcare Provider Details

I. General information

NPI: 1013387265
Provider Name (Legal Business Name): MECHELLE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MECHELLE DAVIS MAYS

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015 HEARNE AVE
SHREVEPORT LA
71108-3803
US

IV. Provider business mailing address

4812 GREEN FOREST CIR
SHREVEPORT LA
71118-2849
US

V. Phone/Fax

Practice location:
  • Phone: 318-213-0904
  • Fax: 318-213-0905
Mailing address:
  • Phone: 318-210-7119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8081
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8081
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: