Provider Demographics
NPI:1962952069
Name:DAVIS, AUDREY Z (LPC)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:Z
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 1:20079 STONE OAK PKWY
Mailing Address - Street 2:SUITE 1275
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-6942
Mailing Address - Country:US
Mailing Address - Phone:210-481-3727
Mailing Address - Fax:
Practice Address - Street 1:20079 STONE OAK PKWY
Practice Address - Street 2:SUITE 1275
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-6942
Practice Address - Country:US
Practice Address - Phone:210-481-3727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62917101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional