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NPI Code Detail

MEDICARE: JANET DAVIS

MEDICARE: JANET DAVIS
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1033665401
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANET DAVIS
Provider Business Mailing Address
First Line : 4019 GREENWOOD RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71109-6422
Country : US
Telephone Number : 318-626-5462
Fax Number : 318-626-5562
Provider Business Practice Location Address
First Line : 4019 GREENWOOD RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71109-6422
Country : US
Telephone Number : 318-626-5462
Fax Number : 318-626-5562
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2016
Last Update Date : 08/26/2016

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Directions to “ JANET DAVIS ” Practice Location

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