1023170941 NPI number — MR. MANUEL TERRY DAVIS JR. MS, LPC

Table of content: MR. MANUEL TERRY DAVIS JR. MS, LPC (NPI 1023170941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023170941 NPI number — MR. MANUEL TERRY DAVIS JR. MS, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
MANUEL
Provider Middle Name:
TERRY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MS, 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:
1023170941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7100 ALMEDA RD APT 1807
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77054-2134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-457-4372
Provider Business Mailing Address Fax Number:
713-457-0945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9100 SOUTHWEST FWY
Provider Second Line Business Practice Location Address:
SUITE 151
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77074-1519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-457-4372
Provider Business Practice Location Address Fax Number:
713-457-0945
Provider Enumeration Date:
12/15/2006

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:  19405 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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