Healthcare Provider Details

I. General information

NPI: 1407186380
Provider Name (Legal Business Name): MS. CASSANDREA DAVIDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2009
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 E SKELLY DR SUITE 200
TULSA OK
74105-6241
US

IV. Provider business mailing address

1638 S CARSON AVE APT 512
TULSA OK
74119-4229
US

V. Phone/Fax

Practice location:
  • Phone: 918-592-1622
  • Fax: 918-392-3328
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: