MEDICARE: MS. ROSA LEE DAVIS M.ED., 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	13128	TX

General Provider Information

NPI Number	:	1770577876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSA LEE DAVIS M.ED., LPC

Provider Business Mailing Address
First Line	:	501 MANTOOTH AVE
Second Line	:
City	:	LUFKIN
State	:	TX
Zip	:	75904-3014
Country	:	US
Telephone Number	:	936-639-4993
Fax Number	:	936-639-6838

Provider Business Practice Location Address
First Line	:	1320 E HOUSTON AVE
Second Line	:
City	:	CROCKETT
State	:	TX
Zip	:	75835-1761
Country	:	US
Telephone Number	:	936-544-9484
Fax Number	:	936-544-9749

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	07/08/2007

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