Healthcare Provider Details

I. General information

NPI: 1568398535
Provider Name (Legal Business Name): JEFFREY T DAVIS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 E WALNUT ST
COLUMBIA MO
65201-6425
US

IV. Provider business mailing address

PO BOX 844715
KANSAS CITY MO
64184-4715
US

V. Phone/Fax

Practice location:
  • Phone: 573-777-7500
  • Fax: 573-777-7505
Mailing address:
  • Phone: 417-761-5214
  • Fax: 417-761-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2026002221
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: