MEDICARE: COURTNEY DAVIS LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	104100000X	Social Worker

General Provider Information

NPI Number	:	1568854487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY DAVIS LMHC

Provider Business Mailing Address
First Line	:	267 PORT RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-1704
Country	:	US
Telephone Number	:	718-981-8117
Fax Number	:

Provider Business Practice Location Address
First Line	:	267 PORT RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-1704
Country	:	US
Telephone Number	:	718-981-8117
Fax Number	:

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

Provider Enumeration Date	:	03/02/2015
Last Update Date	:	09/08/2016

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