Provider Demographics
NPI:1851632277
Name:DAVIS, EMILY A (MSCP, LLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSCP, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 KIPLING AVE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1519
Mailing Address - Country:US
Mailing Address - Phone:248-675-7748
Mailing Address - Fax:
Practice Address - Street 1:89 W SOUTH BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085
Practice Address - Country:US
Practice Address - Phone:800-693-1916
Practice Address - Fax:248-693-1916
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015074103T00000X
MI6361005093103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist