Provider Demographics
NPI:1427494145
Name:DAVIS, JOHN BRADLEY (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:BRADLEY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E MOUNTCASTLE DR STE A
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2539
Mailing Address - Country:US
Mailing Address - Phone:423-516-9018
Mailing Address - Fax:
Practice Address - Street 1:110 E MOUNTCASTLE DR STE A
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2539
Practice Address - Country:US
Practice Address - Phone:423-516-9018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3925101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty