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NPI Code Detail

MEDICARE: CLARK ALLEN DAVIS

MEDICARE: CLARK ALLEN DAVIS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1710510110
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLARK ALLEN DAVIS
Provider Business Mailing Address
First Line : 8339 SPRUCE ST
Second Line :
City : ANCHORAGE
State : AK
Zip : 99507-3242
Country : US
Telephone Number : 907-717-9175
Fax Number :
Provider Business Practice Location Address
First Line : 3710 E 20TH AVE
Second Line :
City : ANCHORAGE
State : AK
Zip : 99508-3418
Country : US
Telephone Number : 907-222-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2020
Last Update Date : 04/21/2022

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Directions to “ CLARK ALLEN DAVIS ” Practice Location

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