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General NPI Number Information
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NPI Number | 1326166141
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Entity Type | Individual
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Provider Name | MARK LYNN DAVIS CADC I
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Gender | Male
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 182 SW ACADEMY ST
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City | DALLAS
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State | OR
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Zip | 97338-1996
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Country | US
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Telephone | 503-623-9289
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Fax |
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Provider Business Mailing Address
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Address Line | 1128 S 7TH ST
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City | INDEPENDENCE
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State | OR
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Zip | 97351-1428
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Country | US
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Telephone | 503-838-4282
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 98-04-13
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License Number State | OR
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