Provider Demographics
NPI:1306384276
Name:DAVIS, JOHN CHASE (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CHASE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 W LAMBERTH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-5181
Mailing Address - Country:US
Mailing Address - Phone:254-249-6530
Mailing Address - Fax:903-200-1505
Practice Address - Street 1:825 DILIGENCE DR STE 102
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4211
Practice Address - Country:US
Practice Address - Phone:254-249-6530
Practice Address - Fax:903-200-1505
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-23-65324103K00000X
VA0133003020103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1306384276Medicaid