MEDICARE: LEE DAVIS

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1316283641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE DAVIS

Provider Business Mailing Address
First Line	:	914 NE 31ST ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-7622
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	914 NE 31ST ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-7622
Country	:	US
Telephone Number	:	405-200-5119
Fax Number	:

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

Provider Enumeration Date	:	12/13/2012
Last Update Date	:	12/13/2012

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Directions to “ LEE DAVIS ” Practice Location

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