1952480360 NPI number — ANNALEE C DAVIS LCSW

Table of content: ANNALEE C DAVIS LCSW (NPI 1952480360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952480360 NPI number — ANNALEE C DAVIS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
ANNALEE
Provider Middle Name:
C
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:
1952480360
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:
6714 E 76TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74133-3422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-594-5295
Provider Business Mailing Address Fax Number:
918-879-4370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3227 E 31ST ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74105-2453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-260-4556
Provider Business Practice Location Address Fax Number:
918-879-4370
Provider Enumeration Date:
11/04/2006

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: 1041C0700X , with the licence number:  1200 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: 035 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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