MEDICARE: DAVIS COUNSELING GROUP

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	101YM0800X	Mental Health Counselor

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

General Provider Information

NPI Number	:	1477380988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVIS COUNSELING GROUP

Provider Business Mailing Address
First Line	:	3940 PENINSULAR DR SE STE 230
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-6187
Country	:	US
Telephone Number	:	501-319-3899
Fax Number	:

Provider Business Practice Location Address
First Line	:	5030 CORPORATE EXCHANGE BLVD SE FL 2
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49512-5506
Country	:	US
Telephone Number	:	616-315-1226
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TRISTEN M DAVIS
Credential	:
Telephone Number	:	501-319-3899

Provider Enumeration Date	:	09/18/2024
Last Update Date	:	09/18/2024

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