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General NPI Number Information
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NPI Number | 1013387265
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Entity Type | Individual
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Provider Name | MECHELLE DAVIS
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Gender | Female
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Dates
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Enumeration Date | 09/30/2015
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 6015 HEARNE AVE
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City | SHREVEPORT
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State | LA
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Zip | 71108-3803
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Country | US
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Telephone | 318-213-0904
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Fax | 318-213-0905
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Provider Business Mailing Address
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Address Line | 4812 GREEN FOREST CIR
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City | SHREVEPORT
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State | LA
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Zip | 71118-2849
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Country | US
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Telephone | 318-210-7119
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8081
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 8081
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License Number State | LA
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