| Doctor Name: | DR. GROVER JEROME DAVIS |
| NPI Number: | 1154423861 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCPC, LMFT |
| License Number: | |
| Business Practice Address: | 15475 S Park Ave Ste 102b South Holland, IL - 604731378 |
| Business Phone Number: | 7083339556 |
| Business Fax Number: | 7083339506 |
| Mailing Address: | 18154 Vermont Ct, ORLAND PARK |
| State: | IL |
| Postal Code: | 604678989 |
| Phone Number: | 7084797519 |
| Fax Number: | 7083339506 |
| NPI Enumeration Date: | 09/02/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |