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General NPI Number Information
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NPI Number | 1689899502
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Entity Type | Individual
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Provider Name | CHARLES NELSON DAVIS LMFT
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Gender | Male
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 1730 E 3100 N STE 2
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City | LAYTON
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State | UT
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Zip | 84040-2408
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Country | US
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Telephone | 801-643-1652
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Fax | 801-779-7808
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Provider Business Mailing Address
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Address Line | 1730 E 3100 N STE 2
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City | LAYTON
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State | UT
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Zip | 84040-2408
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Country | US
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Telephone | 801-643-1652
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Fax | 801-779-7808
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 5891951-3904
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License Number State | UT
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