MEDICARE: ANGELA 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	12029	TX

General Provider Information

NPI Number	:	1225730203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA DAVIS

Provider Business Mailing Address
First Line	:	2616 S LOOP W STE 420
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2769
Country	:	US
Telephone Number	:	713-568-9506
Fax Number	:

Provider Business Practice Location Address
First Line	:	2616 S LOOP W STE 420
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2769
Country	:	US
Telephone Number	:	713-568-9506
Fax Number	:

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

Provider Enumeration Date	:	03/21/2023
Last Update Date	:	03/21/2023

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