Provider Demographics
NPI:1215382379
Name:SHRYER, DAVIS M III (LADC, LPCC)
Entity type:Individual
Prefix:
First Name:DAVIS
Middle Name:M
Last Name:SHRYER
Suffix:III
Gender:M
Credentials:LADC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 5TH ST E APT 1408
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2965
Mailing Address - Country:US
Mailing Address - Phone:651-308-5540
Mailing Address - Fax:
Practice Address - Street 1:195 5TH STREET EAST
Practice Address - Street 2:#1408
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101
Practice Address - Country:US
Practice Address - Phone:651-308-5540
Practice Address - Fax:763-537-6666
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC13026101YP2500X
MN302852101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)