Provider Demographics
NPI:1962988642
Name:DAVIS, ELIZABETH BOATRIGHT (LMFTA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BOATRIGHT
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 S WILBUR AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-9360
Mailing Address - Country:US
Mailing Address - Phone:210-268-3722
Mailing Address - Fax:
Practice Address - Street 1:2330 EASTGATE ST STE 140
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1589
Practice Address - Country:US
Practice Address - Phone:509-676-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60782219106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist