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NPI Code Detail

MEDICARE: MS. KRISTINE ANNE DAVIS PCC

MEDICARE: MS. KRISTINE ANNE DAVIS PCC
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
1101YM0800XMental Health CounselorE3372OH

General Provider Information

NPI Number : 1770805962
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KRISTINE ANNE DAVIS PCC
Provider Business Mailing Address
First Line : 230 S COURT ST
Second Line : SUITE 5
City : MEDINA
State : OH
Zip : 44256-2275
Country : US
Telephone Number : 330-723-7977
Fax Number : 330-725-5177
Provider Business Practice Location Address
First Line : 230 S COURT ST
Second Line : SUITE 5
City : MEDINA
State : OH
Zip : 44256-2275
Country : US
Telephone Number : 330-723-7977
Fax Number : 330-725-5177
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2010
Last Update Date : 04/28/2010

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