| Doctor Name: | DR. BRYAN M DAVIDSON |
| NPI Number: | 1225015035 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 20041751A |
| Business Practice Address: | 4102 Pinion Dr Suite 100 U S A F Academy, CO - 808402502 |
| Business Phone Number: | 7193335797 |
| Business Fax Number: | |
| Mailing Address: | 4413 E Bighorn Dr, Apt A U S A F ACADEMY |
| State: | CO |
| Postal Code: | 808401189 |
| Phone Number: | 7194720278 |
| Fax Number: | |
| NPI Enumeration Date: | 12/22/2005 |
| NPI Last Update Date: | 10/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 20041751A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |