Provider Demographics
NPI:1891972279
Name:DAVIS, RUTHANN (PHD)
Entity type:Individual
Prefix:DR
First Name:RUTHANN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 DUNSARY LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-9447
Mailing Address - Country:US
Mailing Address - Phone:810-227-4935
Mailing Address - Fax:810-227-4935
Practice Address - Street 1:2900 DUNSARY LN
Practice Address - Street 2:SUITE A
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-9447
Practice Address - Country:US
Practice Address - Phone:810-227-4935
Practice Address - Fax:810-227-4935
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003854103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical