| Doctor Name: | MR. KEN D DAVIS |
| NPI Number: | 1013176890 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CDPT |
| License Number: | RC00059734 |
| Business Practice Address: | 1305 Mansfield St Suite 5 Richland, WA - 993523588 |
| Business Phone Number: | 5099421624 |
| Business Fax Number: | |
| Mailing Address: | 6916 W Octave St, PASCO |
| State: | WA |
| Postal Code: | 993012038 |
| Phone Number: | 5095313467 |
| Fax Number: | |
| NPI Enumeration Date: | 06/05/2008 |
| NPI Last Update Date: | 06/05/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | RC00059734 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |