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General NPI Number Information
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NPI Number | 1740983105
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Entity Type | Individual
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Provider Name | SHANTE FELICIA CLARK-DAVIS LPC
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Gender | Female
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Dates
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Enumeration Date | 03/24/2023
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 1127 AUBURN VIEW LN
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City | FRESNO
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State | TX
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Zip | 77545-2049
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Country | US
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Telephone | 281-740-7245
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Fax |
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Provider Business Mailing Address
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Address Line | 6140 HIGHWAY 6 # 1318
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City | MISSOURI CITY
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State | TX
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Zip | 77459-3802
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Country | US
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Telephone | 832-736-4201
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 87461
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License Number State | TX
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