MEDICARE: ARDAVIS & ASSOCIATES, LLC

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	:	1457993412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARDAVIS & ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	2151 W WHITE OAKS DR STE D
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-6410
Country	:	US
Telephone Number	:	217-697-7215
Fax Number	:

Provider Business Practice Location Address
First Line	:	2151 W WHITE OAKS DR STE D
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-6410
Country	:	US
Telephone Number	:	217-697-7215
Fax Number	:

Authorized Official
Title or Position	:	MEMBER, MANAGER
Name	:	AMANDA R DAVIS
Credential	:	LCPC
Telephone Number	:	217-697-7215

Provider Enumeration Date	:	10/11/2019
Last Update Date	:	10/11/2019

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