=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811477441
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOYCE ELAINE DAVIDSON PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2018
-----------------------------------------------------
Last Update Date | 01/07/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2515 UNIVERSITY BLVD STE 102
-----------------------------------------------------
City | AMES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50010-8628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-451-3895
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2515 UNIVERSITY BLVD STE 102
-----------------------------------------------------
City | AMES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50010-8628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-451-3895
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | 00962
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------