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NPI Code Detail

MEDICARE: JOHN DAVID DAVIS LAT

MEDICARE: JOHN DAVID DAVIS LAT
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLAT-241WY
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1154059681
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN DAVID DAVIS LAT
Provider Business Mailing Address
First Line : 748 MAIN ST
Second Line :
City : LANDER
State : WY
Zip : 82520-3036
Country : US
Telephone Number : 307-332-2231
Fax Number :
Provider Business Practice Location Address
First Line : 748 MAIN ST
Second Line :
City : LANDER
State : WY
Zip : 82520-3036
Country : US
Telephone Number : 307-332-2231
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2022
Last Update Date : 12/05/2025

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