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General NPI Number Information
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NPI Number | 1518263037
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Entity Type | Individual
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Provider Name | PHILLIP LEE DAVIS NCC, LMHC
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Gender | Male
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Dates
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Enumeration Date | 01/31/2011
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 120 N HIGHWAY 1
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City | BIRMINGHAM
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State | IA
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Zip | 52535-7700
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Country | US
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Telephone | 641-455-0636
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Fax | 319-498-4246
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Provider Business Mailing Address
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Address Line | 18219 150TH ST
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City | DOUDS
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State | IA
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Zip | 52551-8036
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Country | US
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Telephone | 641-919-3465
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 001316
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 00116
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License Number State | IA
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