MEDICARE: FRANK DAVIS IV

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	88203	TX

General Provider Information

NPI Number	:	1871236000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANK DAVIS IV

Provider Business Mailing Address
First Line	:	107 LUTHER DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-2018
Country	:	US
Telephone Number	:	210-367-2810
Fax Number	:

Provider Business Practice Location Address
First Line	:	11467 HUEBNER RD STE 251
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-1073
Country	:	US
Telephone Number	:	210-900-0725
Fax Number	:

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

Provider Enumeration Date	:	04/15/2022
Last Update Date	:	04/15/2022

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