Healthcare Provider Details

I. General information

NPI: 1851630594
Provider Name (Legal Business Name): PHYLLIS C. DAVIS M.ED., M.S. ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 MATSON AVE
CINCINNATI OH
45236-2509
US

IV. Provider business mailing address

11484 OXFORDSHIRE LN
CINCINNATI OH
45240-2135
US

V. Phone/Fax

Practice location:
  • Phone: 513-936-5923
  • Fax: 513-891-2930
Mailing address:
  • Phone: 513-742-2423
  • Fax: 513-891-2930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberKY1014651
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: