Provider Demographics
NPI:1306556956
Name:DAVIS, HANNAH MYRICK (MA, BCBA, LBS)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:MYRICK
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, BCBA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7562 CLOVER LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-8947
Mailing Address - Country:US
Mailing Address - Phone:610-401-1641
Mailing Address - Fax:
Practice Address - Street 1:2550 INTERSTATE DR STE 201
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9614
Practice Address - Country:US
Practice Address - Phone:717-461-9018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH005522103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst