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NPI Code Detail

MEDICARE: ESTHER DAVIS

MEDICARE:   ESTHER  DAVIS
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 Counselor

General Provider Information

NPI Number : 1912534280
Entity Type Code : Individual
Provider Name (Legal Business Name) : ESTHER DAVIS
Provider Business Mailing Address
First Line : 1403 SILVER LAKE RD NW STE 2
Second Line :
City : NEW BRIGHTON
State : MN
Zip : 55112-9308
Country : US
Telephone Number : 763-221-6866
Fax Number :
Provider Business Practice Location Address
First Line : 1403 SILVER LAKE RD NW STE 2
Second Line :
City : NEW BRIGHTON
State : MN
Zip : 55112-9308
Country : US
Telephone Number : 763-221-6866
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2020
Last Update Date : 03/25/2020

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Directions to “ ESTHER DAVIS ” Practice Location

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