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General NPI Number Information
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NPI Number | 1114154499
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Entity Type | Individual
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Provider Name | MICHELE L DAVIS MSW
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Gender | Female
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Dates
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Enumeration Date | 06/15/2009
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Last Update Date | 06/15/2009
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Provider Practice Location Address
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Address Line | 2035 MESQUITE AVE STE E
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5894
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Country | US
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Telephone | 928-680-0090
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Fax |
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Provider Business Mailing Address
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Address Line | 7279 E CONESTOGA WAY
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-5182
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Country | US
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Telephone | 928-680-0090
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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 | 781
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License Number State | AK
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