1306186978 NPI number — MICHAEL JAMES DAVIS LPC

Table of content: MICHAEL JAMES DAVIS LPC (NPI 1306186978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306186978 NPI number — MICHAEL JAMES DAVIS LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
MICHAEL
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306186978
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 CONCORD CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAIN VALLEY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64029-9719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-824-1989
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1524 NE 96TH ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERTY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64068-1380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-379-3007
Provider Business Practice Location Address Fax Number:
816-379-3745
Provider Enumeration Date:
02/19/2013

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: 101YP2500X , with the licence number:  2012040750 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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