Healthcare Provider Details

I. General information

NPI: 1588064216
Provider Name (Legal Business Name): LAUREN ANN DAVIDSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15820 ADDISON RD
ADDISON TX
75001-3549
US

IV. Provider business mailing address

15820 ADDISON RD
ADDISON TX
75001-3549
US

V. Phone/Fax

Practice location:
  • Phone: 214-575-2999
  • Fax: 215-575-2727
Mailing address:
  • Phone: 214-575-2999
  • Fax: 215-575-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number53548
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: