Provider Demographics
NPI:1962514364
Name:DAVIS, PATRICIA SIMPSON (LPC)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:SIMPSON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 E CALHOUN
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437
Mailing Address - Country:US
Mailing Address - Phone:979-543-4600
Mailing Address - Fax:979-543-5269
Practice Address - Street 1:317 W CALHOUN ST
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-4211
Practice Address - Country:US
Practice Address - Phone:979-543-4600
Practice Address - Fax:979-543-5269
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12412101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2967LCOtherBLUE CROSS BLUE SHIELD
TX155459OtherVALUE OPTIONS