Provider Demographics
NPI:1427346964
Name:DAVIS, LISA C (AS)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:C
Last Name:DAVIS
Suffix:
Gender:F
Credentials:AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13600 S 285TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-7015
Mailing Address - Country:US
Mailing Address - Phone:918-630-3161
Mailing Address - Fax:
Practice Address - Street 1:13600 S 285TH EAST AVE
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429-7015
Practice Address - Country:US
Practice Address - Phone:918-630-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health