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General NPI Number Information
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NPI Number | 1770197840
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Entity Type | Individual
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Provider Name | MR. WENDELL DORCELL DAVIS
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Gender | Male
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 3411 73RD ST
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City | LUBBOCK
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State | TX
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Zip | 79423-1101
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Country | US
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Telephone | 806-797-2247
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Fax |
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Provider Business Mailing Address
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Address Line | 6615 BELMONT AVE
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City | LUBBOCK
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State | TX
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Zip | 79424-1507
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Country | US
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Telephone | 806-239-2399
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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 | 67546
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License Number State | TX
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