Provider Demographics
NPI:1124277140
Name:DAVIS, GAYLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10213 TIMBER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-6026
Mailing Address - Country:US
Mailing Address - Phone:214-202-3929
Mailing Address - Fax:972-620-2969
Practice Address - Street 1:511 E JOHN CARPENTER FWY
Practice Address - Street 2:SUITE 436
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3911
Practice Address - Country:US
Practice Address - Phone:214-202-3929
Practice Address - Fax:972-620-2969
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17111104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker