| Doctor Name: | MR. KENNETH LEE DAVIS |
| NPI Number: | 1023143021 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CPSW, CPSC, MSD, DD |
| License Number: | RC00056544 |
| Business Practice Address: | 184 Unser Blvd Ne Rio Rancho, NM - 871244045 |
| Business Phone Number: | 5058960928 |
| Business Fax Number: | 5049940209 |
| Mailing Address: | 177b El Cerro Mission Rd, LOS LUNAS |
| State: | NM |
| Postal Code: | 870317874 |
| Phone Number: | 5052402399 |
| Fax Number: | |
| NPI Enumeration Date: | 02/22/2007 |
| NPI Last Update Date: | 04/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | RC00056544 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |