Healthcare Provider Details

I. General information

NPI: 1538971676
Provider Name (Legal Business Name): HALLIE A DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3757 FISHCREEK RD
STOW OH
44224-5404
US

IV. Provider business mailing address

960 GRAHAM RD
CUYAHOGA FALLS OH
44221-1155
US

V. Phone/Fax

Practice location:
  • Phone: 330-606-9262
  • Fax:
Mailing address:
  • Phone: 330-606-9262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2506746
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: