1184974420 NPI number — KERRY K DAVIES LCSW

Table of content: KERRY K DAVIES LCSW (NPI 1184974420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184974420 NPI number — KERRY K DAVIES LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIES
Provider First Name:
KERRY
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

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:
1184974420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12337 HANCOCK ST
Provider Second Line Business Mailing Address:
STE 20
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46032-5885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-706-6744
Provider Business Mailing Address Fax Number:
317-706-6700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12337 HANCOCK ST
Provider Second Line Business Practice Location Address:
STE 20
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46032-5885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-706-6744
Provider Business Practice Location Address Fax Number:
317-706-6700
Provider Enumeration Date:
09/13/2012

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:  34006630A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 201178980A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201163980 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: IN1231 . This is a "MEDICARE GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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