MEDICARE: MRS. CHRISTINE ANN DAVIS LMT, BCTMB

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	101YM0800X	Mental Health Counselor
2	225700000X	Massage Therapist	7501006138	MI

General Provider Information

NPI Number	:	1205186434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE ANN DAVIS LMT, BCTMB

Provider Business Mailing Address
First Line	:	3111 ELECTRIC AVE
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-8127
Country	:	US
Telephone Number	:	810-966-4480
Fax Number	:

Provider Business Practice Location Address
First Line	:	4351 24TH AVE STE 5
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-4506
Country	:	US
Telephone Number	:	810-385-7405
Fax Number	:

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

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	03/20/2023

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