Doctor Name: | MYESHA DAVIS |
NPI Number: | 1023478724 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 12848 |
Business Practice Address: | 2800 Youree Dr Suite 369 Shreveport, LA - 711043661 |
Business Phone Number: | 3186714341 |
Business Fax Number: | |
Mailing Address: | 2800 Youree Dr, Suite 369 SHREVEPORT |
State: | LA |
Postal Code: | 711043661 |
Phone Number: | 3186714341 |
Fax Number: | |
NPI Enumeration Date: | 02/24/2016 |
NPI Last Update Date: | 02/24/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 12848 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |