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General NPI Number Information
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NPI Number | 1215382379
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Entity Type | Individual
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Provider Name | DAVIS M SHRYER III LADC, LPCC
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Gender | Male
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 195 5TH STREET EAST #1408
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City | SAINT PAUL
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State | MN
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Zip | 55101
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Country | US
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Telephone | 651-308-5540
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Fax | 763-537-6666
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Provider Business Mailing Address
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Address Line | 195 5TH ST E APT 1408
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City | SAINT PAUL
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State | MN
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Zip | 55101-2965
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Country | US
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Telephone | 651-308-5540
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC13026
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 302852
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License Number State | MN
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