MEDICARE: MS. TAMARA JO DAVIDSON LPC

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	101YP2500X	Professional Counselor	2014044168	MO

General Provider Information

NPI Number	:	1619531688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMARA JO DAVIDSON LPC

Provider Business Mailing Address
First Line	:	7630 MCGEE ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-1941
Country	:	US
Telephone Number	:	816-405-5434
Fax Number	:

Provider Business Practice Location Address
First Line	:	7630 MCGEE ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-1941
Country	:	US
Telephone Number	:	816-405-5434
Fax Number	:

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

Provider Enumeration Date	:	04/25/2019
Last Update Date	:	11/01/2021

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