Provider Demographics
NPI:1124168943
Name:DAVIS, JAMES BRADEN (EDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BRADEN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 W MERRILL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT DAVID
Mailing Address - State:AZ
Mailing Address - Zip Code:85630-6147
Mailing Address - Country:US
Mailing Address - Phone:520-720-5363
Mailing Address - Fax:520-720-5363
Practice Address - Street 1:338 W MERRILL DR
Practice Address - Street 2:
Practice Address - City:SAINT DAVID
Practice Address - State:AZ
Practice Address - Zip Code:85630-6147
Practice Address - Country:US
Practice Address - Phone:520-720-5363
Practice Address - Fax:520-720-5363
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool