Healthcare Provider Details

I. General information

NPI: 1144748997
Provider Name (Legal Business Name): KELLY ANN DAVIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 OHIO PIKE STE 198S
CINCINNATI OH
45255-3637
US

IV. Provider business mailing address

431 OHIO PIKE STE 198S
CINCINNATI OH
45255-3637
US

V. Phone/Fax

Practice location:
  • Phone: 513-770-1705
  • Fax: 513-770-1705
Mailing address:
  • Phone: 513-770-1705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC1700568
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: