Doctor Name: | CARL DAVIS |
NPI Number: | 1134476765 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 324 E Chestnut St Coweta, OK - 744292532 |
Business Phone Number: | 9182796565 |
Business Fax Number: | |
Mailing Address: | 13600 S 285th East Ave, COWETA |
State: | OK |
Postal Code: | 744297015 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 08/14/2012 |
NPI Last Update Date: | 08/14/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |