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General NPI Number Information
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NPI Number | 1114437548
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Entity Type | Individual
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Provider Name | SAMANTHA LEE DAVIS M.ED, BCBA
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Gender | Female
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Dates
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Enumeration Date | 10/12/2017
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Last Update Date | 11/15/2018
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Provider Practice Location Address
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Address Line | 22461 I-30 FRONTAGE RD 1100B
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City | BRYANT
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State | AR
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Zip | 72022
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Country | US
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Telephone | 501-574-3053
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Fax |
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Provider Business Mailing Address
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Address Line | 22641 FRONTAGE RD
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City | BRYANT
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State | AR
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Zip | 72022-9117
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Country | US
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Telephone | 501-547-3053
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | C-022
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-18-31009
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License Number State |
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