Provider Demographics
NPI:1972771277
Name:DAVENPORT, ANNETTE (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 NW 105TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-5203
Mailing Address - Country:US
Mailing Address - Phone:405-306-9405
Mailing Address - Fax:
Practice Address - Street 1:1341 NW 105TH TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-5203
Practice Address - Country:US
Practice Address - Phone:405-306-9405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3304101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional