MEDICARE: MR. ERIC L. DAVIS LCSW

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
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	34005462A	IN

General Provider Information

NPI Number	:	1518119148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC L. DAVIS LCSW

Provider Business Mailing Address
First Line	:	1515 E MILLS AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-3736
Country	:	US
Telephone Number	:	317-887-3290
Fax Number	:

Provider Business Practice Location Address
First Line	:	8110 MADISON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6076
Country	:	US
Telephone Number	:	317-887-3290
Fax Number	:

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

Provider Enumeration Date	:	10/14/2008
Last Update Date	:	10/14/2008

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