MEDICARE: DEBBIE DAVIS LMHC LLC

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	12512	FL

General Provider Information

NPI Number	:	1740688399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBBIE DAVIS LMHC LLC

Provider Business Mailing Address
First Line	:	2457 3RD ST S
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-4066
Country	:	US
Telephone Number	:	904-307-8123
Fax Number	:	904-645-5289

Provider Business Practice Location Address
First Line	:	2457 3RD ST S
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-4066
Country	:	US
Telephone Number	:	904-307-8123
Fax Number	:	904-645-5289

Authorized Official
Title or Position	:	OWNER
Name	:	DEBORAH DAVIS
Credential	:	LMHC
Telephone Number	:	904-307-8123

Provider Enumeration Date	:	12/15/2014
Last Update Date	:	12/15/2014

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