MEDICARE: MR. MANUEL TERRY DAVIS JR. MS, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	19405	TX

General Provider Information

NPI Number	:	1023170941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MANUEL TERRY DAVIS JR. MS, LPC

Provider Business Mailing Address
First Line	:	7100 ALMEDA RD APT 1807
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2134
Country	:	US
Telephone Number	:	713-457-4372
Fax Number	:	713-457-0945

Provider Business Practice Location Address
First Line	:	9100 SOUTHWEST FWY
Second Line	:	SUITE 151
City	:	HOUSTON
State	:	TX
Zip	:	77074-1519
Country	:	US
Telephone Number	:	713-457-4372
Fax Number	:	713-457-0945

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/08/2007

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