Healthcare Provider Details

I. General information

NPI: 1538673371
Provider Name (Legal Business Name): CATHERINE ELISE DAVIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATHERINE ELISE WALLENBROCK

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 E BROAD ST
COLUMBUS OH
43213-2086
US

IV. Provider business mailing address

PO BOX 1421
COLUMBUS OH
43216-1421
US

V. Phone/Fax

Practice location:
  • Phone: 614-655-3345
  • Fax:
Mailing address:
  • Phone: 614-753-0836
  • Fax: 614-389-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.1700519
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1700519
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: