MEDICARE: ANDREW JAMES DAVIS BA

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1134353816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW JAMES DAVIS BA

Provider Business Mailing Address
First Line	:	963 LOGAN ST
Second Line	:	#22
City	:	DENVER
State	:	CO
Zip	:	80203-3017
Country	:	US
Telephone Number	:	720-880-8892
Fax Number	:

Provider Business Practice Location Address
First Line	:	963 LOGAN ST
Second Line	:	#22
City	:	DENVER
State	:	CO
Zip	:	80203-3017
Country	:	US
Telephone Number	:	720-880-8892
Fax Number	:

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

Provider Enumeration Date	:	05/08/2009
Last Update Date	:	05/08/2009

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