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General NPI Number Information
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NPI Number | 1063399061
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Entity Type | Individual
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Provider Name | JUELZ DAVIS
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Gender | Male
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Dates
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Enumeration Date | 08/20/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 1131 OAK AVE NW
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City | CANTON
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State | OH
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Zip | 44708-4066
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Country | US
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Telephone | 234-203-9661
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Fax |
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Provider Business Mailing Address
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Address Line | 1618 BRYAN AVE SW
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City | CANTON
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State | OH
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Zip | 44706-2524
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Country | US
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Telephone | 234-203-9661
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Fax | 234-203-9661
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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 | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | VB670733
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License Number State | OH
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