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General NPI Number Information
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NPI Number | 1093940017
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Entity Type | Individual
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Provider Name | JOSEPH CLINTON DAVIS
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Gender | Male
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 520 OLIVE ST
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City | SHREVEPORT
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State | LA
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Zip | 71104-2312
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Country | US
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Telephone | 318-446-4141
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Fax | 318-446-4141
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Provider Business Mailing Address
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Address Line | 589 UNADILLA ST
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City | SHREVEPORT
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State | LA
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Zip | 71106-1239
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Country | US
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Telephone | 318-446-4141
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | #4948
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | #4948
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License Number State | LA
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