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NPI Code Detail

MEDICARE: BRIAN W DAVIS LCSW

MEDICARE: BRIAN W DAVIS LCSW
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
11041C0700XClinical Social Worker1930CAL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
151532255OTHERALBCBS
251532854OTHERALFEDERAL BCBS

General Provider Information

NPI Number : 1750338067
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN W DAVIS LCSW
Provider Business Mailing Address
First Line : 110 SKYLINE DRIVE
Second Line :
City : RUSSELLVILLE
State : AR
Zip : 72801
Country : US
Telephone Number : 479-967-5570
Fax Number : 479-890-5364
Provider Business Practice Location Address
First Line : 350 SALEM RD STE 1
Second Line :
City : CONWAY
State : AR
Zip : 72034-6166
Country : US
Telephone Number : 501-336-8300
Fax Number : 479-890-5364
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2006
Last Update Date : 07/21/2022

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