MEDICARE: MS. CAROL JEAN DAVIS-RIOS LCSW

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	1041C0700X	Clinical Social Worker	22797	TX

General Provider Information

NPI Number	:	1275845786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL JEAN DAVIS-RIOS LCSW

Provider Business Mailing Address
First Line	:	2908 PUEBLO CT S
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-7709
Country	:	US
Telephone Number	:	979-775-9106
Fax Number	:

Provider Business Practice Location Address
First Line	:	2908 PUEBLO CT S
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-7709
Country	:	US
Telephone Number	:	979-775-9106
Fax Number	:

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

Provider Enumeration Date	:	07/13/2010
Last Update Date	:	10/04/2011

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