Healthcare Provider Details

I. General information

NPI: 1376730242
Provider Name (Legal Business Name): ERICA EVE DAVIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 NW 32ND ST
NEWCASTLE OK
73065-6605
US

IV. Provider business mailing address

650 S PEORIA AVE
TULSA OK
74120-4429
US

V. Phone/Fax

Practice location:
  • Phone: 405-527-2424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7156
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: