Provider Demographics
NPI:1194883132
Name:DAVIS, BONNIE F (LMSW)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:F
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 SKYLINE RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3826
Mailing Address - Country:US
Mailing Address - Phone:512-560-5896
Mailing Address - Fax:
Practice Address - Street 1:211 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2184
Practice Address - Country:US
Practice Address - Phone:512-248-3252
Practice Address - Fax:512-248-3260
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24023104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171M00000XMedicaid