1912215617 NPI number — MS. DRURY JEAN DAVIS L.C.S.W.

Table of content: MS. DRURY JEAN DAVIS L.C.S.W. (NPI 1912215617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912215617 NPI number — MS. DRURY JEAN DAVIS L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
DRURY
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVIS-COLLCUTT
Provider Other First Name:
JEAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.C.S.W.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912215617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2440 S JASMINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80222-6313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-733-7009
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 S SYCAMORE ST
Provider Second Line Business Practice Location Address:
ARAPAHOE DOUGLAS MENTAL HEALTH
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80120-8201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-797-9346
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  21 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)