Provider Demographics
NPI:1104062033
Name:DAVIS, LUTHER EUGENE (PHD)
Entity type:Individual
Prefix:DR
First Name:LUTHER
Middle Name:EUGENE
Last Name:DAVIS
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 HART ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SHEPPARD AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76311-3477
Mailing Address - Country:US
Mailing Address - Phone:940-676-6075
Mailing Address - Fax:940-676-6076
Practice Address - Street 1:11201 BENTON ST # 116A
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357-3477
Practice Address - Country:US
Practice Address - Phone:909-894-7424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-24
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22384103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical