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General NPI Number Information
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NPI Number | 1083340137
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Entity Type | Individual
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Provider Name | EDWARD DAVIS MS
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Gender | Male
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 119 W MAIN ST
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City | EMMETT
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State | ID
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Zip | 83617-2935
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Country | US
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Telephone | 986-895-4507
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Fax | 208-277-3133
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Provider Business Mailing Address
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Address Line | 8401 W IDAHO BLVD
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City | LETHA
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State | ID
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Zip | 83636-7706
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Country | US
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Telephone | 986-895-4507
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Fax | 208-277-3133
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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 | 8331398
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC019860
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License Number State | PA
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