MEDICARE: MRS. LISA G DAVIES PC

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	C.1100503	OH

General Provider Information

NPI Number	:	1740621614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA G DAVIES PC

Provider Business Mailing Address
First Line	:	8038 MARION RD
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-9527
Country	:	US
Telephone Number	:	740-745-2091
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 E GAMBIER ST
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-3510
Country	:	US
Telephone Number	:	740-392-5416
Fax Number	:

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

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	07/08/2013

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