MEDICARE: DR. BETH BREECE DAVIS PHD

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	103TH0004X	Health Psychologist	0810004027	VA
2	103G00000X	Clinical Neuropsychologist

General Provider Information

NPI Number	:	1245206028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETH BREECE DAVIS PHD

Provider Business Mailing Address
First Line	:	13800 COPPERMINE RD
Second Line	:	SUITE 183
City	:	HERNDON
State	:	VA
Zip	:	20171-6163
Country	:	US
Telephone Number	:	619-540-3235
Fax Number	:

Provider Business Practice Location Address
First Line	:	13800 COPPERMINE RD
Second Line	:	SUITE 183
City	:	HERNDON
State	:	VA
Zip	:	20171-6163
Country	:	US
Telephone Number	:	619-540-3235
Fax Number	:

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	02/12/2026

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