MEDICARE: NORA CATHLEEN DAVIS LADC

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	101YP2500X	Professional Counselor	5557	MN
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	306488	MN

General Provider Information

NPI Number	:	1265121552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NORA CATHLEEN DAVIS LADC

Provider Business Mailing Address
First Line	:	2855 ANTHONY LN S STE 201
Second Line	:
City	:	SAINT ANTHONY
State	:	MN
Zip	:	55418-2637
Country	:	US
Telephone Number	:	651-217-1480
Fax Number	:

Provider Business Practice Location Address
First Line	:	2855 ANTHONY LN S STE 201
Second Line	:
City	:	SAINT ANTHONY
State	:	MN
Zip	:	55418-2637
Country	:	US
Telephone Number	:	651-217-1480
Fax Number	:

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

Provider Enumeration Date	:	05/03/2023
Last Update Date	:	04/13/2026

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