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NPI Code Detail

MEDICARE: PROF. TROY JEVON DAVIS

MEDICARE: PROF. TROY JEVON 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1467645614
Entity Type Code : Individual
Provider Name (Legal Business Name) : PROF. TROY JEVON DAVIS
Provider Business Mailing Address
First Line : 1125 W 6TH ST STE 103
Second Line :
City : LOS ANGELES
State : CA
Zip : 90017-1896
Country : US
Telephone Number : 213-202-3970
Fax Number :
Provider Business Practice Location Address
First Line : 1125 W 6TH ST STE 103
Second Line :
City : LOS ANGELES
State : CA
Zip : 90017-1896
Country : US
Telephone Number : 213-202-3970
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2007
Last Update Date : 08/21/2007

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