MEDICARE: MRS. CRYSTAL MARIE DAVIS MA, LLPC

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	6401014693	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902157837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CRYSTAL MARIE DAVIS MA, LLPC

Provider Business Mailing Address
First Line	:	3537 FORT ST
Second Line	:
City	:	WYANDOTTE
State	:	MI
Zip	:	48192-6315
Country	:	US
Telephone Number	:	734-818-9270
Fax Number	:

Provider Business Practice Location Address
First Line	:	3537 FORT ST
Second Line	:
City	:	WYANDOTTE
State	:	MI
Zip	:	48192-6315
Country	:	US
Telephone Number	:	734-818-9270
Fax Number	:

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

Provider Enumeration Date	:	10/02/2012
Last Update Date	:	07/19/2023

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