Healthcare Provider Details

I. General information

NPI: 1801904792
Provider Name (Legal Business Name): LINDA ELLEN DAVIDSON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N MAIN ST
NEVADA MO
64772-2332
US

IV. Provider business mailing address

PO BOX 607
NEVADA MO
64772-0607
US

V. Phone/Fax

Practice location:
  • Phone: 417-667-9608
  • Fax: 417-667-9713
Mailing address:
  • Phone: 417-667-9608
  • Fax: 417-667-9713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number01384
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: