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NPI Code Detail

MEDICARE: MICHAEL D DAVIS LMHC

MEDICARE: MICHAEL D DAVIS LMHC
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
1101Y00000XCounselor5631FL
2101YM0800XMental Health Counselor5631FL
3101YA0400XAddiction (Substance Use Disorder) Counselor5631FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MH5631OTHERFLFLORIDA DEPARTMENT OF HEALTH

General Provider Information

NPI Number : 1295238996
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL D DAVIS LMHC
Provider Business Mailing Address
First Line : 825 W LINEBAUGH AVE
Second Line :
City : TAMPA
State : FL
Zip : 33612-7855
Country : US
Telephone Number : 813-931-5560
Fax Number : 813-932-4960
Provider Business Practice Location Address
First Line : 825 W LINEBAUGH AVE
Second Line :
City : TAMPA
State : FL
Zip : 33612-7855
Country : US
Telephone Number : 813-931-5560
Fax Number : 813-932-4960
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2018
Last Update Date : 03/09/2018

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