Provider Demographics
NPI:1104645159
Name:DAVIS, KELVIN J JR (LPC-A)
Entity type:Individual
Prefix:
First Name:KELVIN
Middle Name:J
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17601 PRESTON RD APT 273
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5753
Mailing Address - Country:US
Mailing Address - Phone:214-735-3977
Mailing Address - Fax:
Practice Address - Street 1:701 HIGHWAY 352 STE A100
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-6897
Practice Address - Country:US
Practice Address - Phone:214-642-9695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93076101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health