Healthcare Provider Details

I. General information

NPI: 1053712265
Provider Name (Legal Business Name): JAZMIN DENISE DAVIS LMSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAZMIN DENISE JONES

II. Dates (important events)

Enumeration Date: 09/07/2014
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20500 EUREKA RD STE 200
TAYLOR MI
48180-6394
US

IV. Provider business mailing address

24383 RENSSELAER ST
OAK PARK MI
48237-1782
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3732
  • Fax: 517-882-3633
Mailing address:
  • Phone: 248-938-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34007909A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801094505
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: