MEDICARE: TIMOTHY L DAVIS 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	LPC 10479	AZ

General Provider Information

NPI Number	:	1770565269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY L DAVIS LPC

Provider Business Mailing Address
First Line	:	1743 SYCAMORE AVE
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86409
Country	:	US
Telephone Number	:	928-757-8111
Fax Number	:	928-757-3256

Provider Business Practice Location Address
First Line	:	1743 SYCAMORE AVE
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86409-0927
Country	:	US
Telephone Number	:	928-757-8111
Fax Number	:	928-757-3256

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/22/2011

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