Provider Demographics
NPI:1386491298
Name:DAVIS, PHELIX KELLY
Entity type:Individual
Prefix:
First Name:PHELIX
Middle Name:KELLY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 OLD SPANISH TRL # B-1246
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-2456
Mailing Address - Country:US
Mailing Address - Phone:281-451-9609
Mailing Address - Fax:
Practice Address - Street 1:3636 OLD SPANISH TRL # B-1246
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-2456
Practice Address - Country:US
Practice Address - Phone:281-451-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No342000000XTransportation ServicesTransportation Network Company