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General NPI Number Information
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NPI Number | 1053034934
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Entity Type | Individual
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Provider Name | CARRISA DAVIS LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | BLDG 36065 590 MEDICAL CENTER RD. 3RD FLOOR, RM 33-133
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City | FORT CAVAZOS
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State | TX
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Zip | 76544
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Country | US
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Telephone | 254-553-0998
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Fax |
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Provider Business Mailing Address
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Address Line | 2408 TRAVERSE DR
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City | KILLEEN
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State | TX
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Zip | 76543-8007
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Country | US
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Telephone | 575-430-3987
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | SWB-2024-0651
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 111665
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License Number State | TX
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