MEDICARE: MS. ANNETTE DAVENPORT MS, 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	101YP2500X	Professional Counselor	3304	OK

General Provider Information

NPI Number	:	1972771277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNETTE DAVENPORT MS, LPC

Provider Business Mailing Address
First Line	:	1341 NW 105TH TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-5203
Country	:	US
Telephone Number	:	405-306-9405
Fax Number	:

Provider Business Practice Location Address
First Line	:	1341 NW 105TH TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-5203
Country	:	US
Telephone Number	:	405-306-9405
Fax Number	:

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

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	02/02/2009

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