1093892515 NPI number — MR. WILLIAM AUGUSTA DAVIS JR. LHMC, LPC, LCDC, MAC

Table of content: MR. WILLIAM AUGUSTA DAVIS JR. LHMC, LPC, LCDC, MAC (NPI 1093892515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093892515 NPI number — MR. WILLIAM AUGUSTA DAVIS JR. LHMC, LPC, LCDC, MAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
WILLIAM
Provider Middle Name:
AUGUSTA
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
LHMC, LPC, LCDC, MAC
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:
1093892515
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BEHAVIORAL HEALTH MEDICINE-MULTI-D CLINIC, BAMC
Provider Second Line Business Mailing Address:
4178 PETROLEUM DRIVE, BLDG 3528R
Provider Business Mailing Address City Name:
FORT SAM HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-916-4242
Provider Business Mailing Address Fax Number:
210-539-5467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BEHAVIORAL HEALTH MEDICINE-MULTI-D CLINIC
Provider Second Line Business Practice Location Address:
3551 ROGER BROOKE DRIVE
Provider Business Practice Location Address City Name:
FORT SAM HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78234-4504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-808-6460
Provider Business Practice Location Address Fax Number:
210-539-9400
Provider Enumeration Date:
11/01/2006

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: 101Y00000X , with the licence number:  75551 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 156855 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 9787 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 178.002744 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: LH 60024561 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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