Provider Demographics
NPI:1336948926
Name:DAVIS, JOHN RUSSELL JR
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RUSSELL
Last Name:DAVIS
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11111 MISSY FALLS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5337
Mailing Address - Country:US
Mailing Address - Phone:832-319-9591
Mailing Address - Fax:
Practice Address - Street 1:11111 MISSY FALLS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5337
Practice Address - Country:US
Practice Address - Phone:832-319-9591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional