| Doctor Name: | LYNNE GRACE DAVIDSON |
| NPI Number: | 1104006618 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LPC |
| License Number: | 2006035744 |
| Business Practice Address: | 1051 Kingshighway St Rolla, MO - 654012938 |
| Business Phone Number: | 5733648511 |
| Business Fax Number: | |
| Mailing Address: | 1051 Kingshighway St, ROLLA |
| State: | MO |
| Postal Code: | 654012938 |
| Phone Number: | 5733648511 |
| Fax Number: | |
| NPI Enumeration Date: | 11/13/2007 |
| NPI Last Update Date: | 10/02/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 2006035744 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |