MEDICARE: WHITNEY J DAVIS LADC, 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	806	OK
2	101YP2500X	Professional Counselor	4121	OK

General Provider Information

NPI Number	:	1093998668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY J DAVIS LADC, LPC

Provider Business Mailing Address
First Line	:	417 E SILAS ST
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74003-3611
Country	:	US
Telephone Number	:	918-337-6050
Fax Number	:	918-337-6061

Provider Business Practice Location Address
First Line	:	417 E SILAS ST
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74003-3611
Country	:	US
Telephone Number	:	918-337-6050
Fax Number	:	918-337-6061

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

Provider Enumeration Date	:	12/06/2007
Last Update Date	:	07/17/2019

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