Healthcare Provider Details

I. General information

NPI: 1245629393
Provider Name (Legal Business Name): STEFANIE ANN DAVIS MS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 01/01/2020
Certification Date: 01/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3754 W INDIAN TRAIL RD
SPOKANE WA
99208-4736
US

IV. Provider business mailing address

3754 W INDIAN TRAIL RD
SPOKANE WA
99208-4736
US

V. Phone/Fax

Practice location:
  • Phone: 509-559-3100
  • Fax: 509-328-7582
Mailing address:
  • Phone: 509-559-3132
  • Fax: 509-328-7582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60722538
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: