Healthcare Provider Details

I. General information

NPI: 1356832018
Provider Name (Legal Business Name): CHELSEA MARIA DAVIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1167 CORPORATE LAKE DR
SAINT LOUIS MO
63132-1716
US

IV. Provider business mailing address

1167 CORPORATE LAKE DR
SAINT LOUIS MO
63132-1716
US

V. Phone/Fax

Practice location:
  • Phone: 314-968-2350
  • Fax:
Mailing address:
  • Phone: 314-488-1038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2017027551
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: