Provider Demographics
NPI:1487760484
Name:DAVID P DAVIS, PH.D., LLC
Entity type:Organization
Organization Name:DAVID P DAVIS, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-461-7207
Mailing Address - Street 1:7195 W FALCON VIEW PASS
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-4986
Mailing Address - Country:US
Mailing Address - Phone:808-756-1863
Mailing Address - Fax:520-352-9602
Practice Address - Street 1:7195 W FALCON VIEW PASS
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85658-4986
Practice Address - Country:US
Practice Address - Phone:808-756-1863
Practice Address - Fax:520-352-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 212103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1619082039OtherINDIVIDUAL NPI
1619082039OtherINDIVIDUAL NPI