Healthcare Provider Details

I. General information

NPI: 1770107187
Provider Name (Legal Business Name): SHAUN DAVIS, PSYD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 N VILLA RD
NEWBERG OR
97132-1858
US

IV. Provider business mailing address

PO BOX 327
YAMHILL OR
97148-0327
US

V. Phone/Fax

Practice location:
  • Phone: 503-495-3870
  • Fax: 971-264-5330
Mailing address:
  • Phone: 503-781-0674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHAUN DAVIS
Title or Position: SOLE MEMBER
Credential: PSYD
Phone: 503-495-3870