=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831287028
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA C DAVIS PH.D,C.HT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2527 S 11TH ST SUITE 2
-----------------------------------------------------
City | NILES
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49120-4747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-683-3299
-----------------------------------------------------
Fax | 269-683-3299
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2527 S 11TH ST SUITE 2
-----------------------------------------------------
City | NILES
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49120-4747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-683-3299
-----------------------------------------------------
Fax | 269-683-3299
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | CHT 696-272
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------