Healthcare Provider Details

I. General information

NPI: 1902607724
Provider Name (Legal Business Name): CYLAS DAVIDSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N PARK ST
ABERDEEN WA
98520-4818
US

IV. Provider business mailing address

151 N MARKET BLVD STE C
CHEHALIS WA
98532-2677
US

V. Phone/Fax

Practice location:
  • Phone: 360-660-1011
  • Fax: 360-660-1009
Mailing address:
  • Phone: 360-660-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCAAR.CG.61670963
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: