MEDICARE: CHARME S. DAVIDSON PH.D., ABPP

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	103T00000X	Psychologist	LP2642	MN
2	106H00000X	Marriage & Family Therapist	MFT0245	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	LP2642	OTHER	MN	MN PSYCHOLOGY LICENSE #
3	0245	OTHER	MN	MN MARRIAGE & FAM LIC #
4	3962	OTHER	MN	ABPP #

General Provider Information

NPI Number	:	1285687889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARME S. DAVIDSON PH.D., ABPP

Provider Business Mailing Address
First Line	:	5401 PLEASANT AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55419-1846
Country	:	US
Telephone Number	:	612-825-2868
Fax Number	:	612-870-4542

Provider Business Practice Location Address
First Line	:	1409 WILLOW ST
Second Line	:	SUITE 220
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-2269
Country	:	US
Telephone Number	:	612-870-0510
Fax Number	:	612-870-4542

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	09/11/2025

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Directions to “ CHARME S. DAVIDSON PH.D., ABPP” Practice Location

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