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General NPI Number Information
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NPI Number | 1477833176
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Entity Type | Individual
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Provider Name | JACLYN MICHELLE DAVIS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/25/2011
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 1515 S CAPITAL OF TEXAS HWY STE 200
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City | AUSTIN
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State | TX
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Zip | 78746-6544
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Country | US
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Telephone | 512-649-1742
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Fax |
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Provider Business Mailing Address
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Address Line | 1045 S CEDAR CREST BLVD
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City | ALLENTOWN
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State | PA
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Zip | 18103-5443
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Country | US
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Telephone | 610-433-3360
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 38202
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS017996
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License Number State | PA
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