Healthcare Provider Details

I. General information

NPI: 1417852492
Provider Name (Legal Business Name): CAROL ANN DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 DUNN RD
HAZELWOOD MO
63042-1740
US

IV. Provider business mailing address

737 DUNN RD
HAZELWOOD MO
63042-1740
US

V. Phone/Fax

Practice location:
  • Phone: 314-731-2433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2026047978
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: