MEDICARE: SHANNON M DAVIS MA, 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	101YM0800X	Mental Health Counselor	TPMC2599	FL
2	101YP2500X	Professional Counselor	79218	TX
3	101Y00000X	Counselor	79218	TX

General Provider Information

NPI Number	:	1942821806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON M DAVIS MA, LPC

Provider Business Mailing Address
First Line	:	512 N HAMPTON RD STE 278
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-4920
Country	:	US
Telephone Number	:	214-903-4434
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 N WATSON RD STE 177
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-6223
Country	:	US
Telephone Number	:	214-903-4434
Fax Number	:

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

Provider Enumeration Date	:	05/01/2020
Last Update Date	:	11/27/2023

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