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General NPI Number Information
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NPI Number | 1336696905
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Entity Type | Individual
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Provider Name | BRYAN DAVIS PC
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Gender | Male
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 4059 ST RT 36/37 EAST SUITE B
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City | DELAWARE
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State | OH
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Zip | 43015-9461
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Country | US
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Telephone | 614-312-7036
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Fax |
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Provider Business Mailing Address
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Address Line | 4059 ST RT 36/37 EAST SUITE B
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City | DELAWARE
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State | OH
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Zip | 43015-9461
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Country | US
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Telephone | 614-312-7036
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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 | C.1200532
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License Number State | OH
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