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NPI Code Detail

MEDICARE: MS. CAROL PATRICIA DAVIS BA

MEDICARE: MS. CAROL PATRICIA DAVIS BA
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
1101Y00000XCounselorNACO

General Provider Information

NPI Number : 1497978050
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CAROL PATRICIA DAVIS BA
Provider Business Mailing Address
First Line : PO BOX 13840
Second Line :
City : FT CARSON
State : CO
Zip : 80913-0840
Country : US
Telephone Number : 719-338-2862
Fax Number :
Provider Business Practice Location Address
First Line : 10 FARRAGUT AVE
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80909-5626
Country : US
Telephone Number : 719-338-2862
Fax Number : 719-634-0482
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2007
Last Update Date : 07/08/2007

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