Provider Demographics
NPI:1902143472
Name:DAVIS, DANIEL (PHD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6475 WADSWORTH BLVD
Mailing Address - Street 2:324
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-4437
Mailing Address - Country:US
Mailing Address - Phone:303-467-2624
Mailing Address - Fax:303-431-8410
Practice Address - Street 1:6475 WADSWORTH BLVD
Practice Address - Street 2:324
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-4437
Practice Address - Country:US
Practice Address - Phone:303-467-2624
Practice Address - Fax:303-431-8410
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4295101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional