Healthcare Provider Details

I. General information

NPI: 1386796688
Provider Name (Legal Business Name): DANIEL L DAVIS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 REED RD SUITE A211
COLUMBUS OH
43220-2553
US

IV. Provider business mailing address

5151 REED RD SUITE A211
COLUMBUS OH
43220-2553
US

V. Phone/Fax

Practice location:
  • Phone: 614-451-6517
  • Fax:
Mailing address:
  • Phone: 614-451-6517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3063
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3063
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number3063
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: