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NPI Code Detail

MEDICARE: JAMIE DAVIS

MEDICARE: JAMIE 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
2101YM0800XMental Health CounselorPROFESSIONALLICENSE

General Provider Information

NPI Number : 1225498413
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE DAVIS
Provider Business Mailing Address
First Line : 3601 W 10TH ST
Second Line :
City : THE DALLES
State : OR
Zip : 97058-4377
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3601 W 10TH ST
Second Line :
City : THE DALLES
State : OR
Zip : 97058-4377
Country : US
Telephone Number : 541-506-3449
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2016
Last Update Date : 05/03/2022

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Directions to “ JAMIE DAVIS ” Practice Location

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