1972842102 NPI number — MS. WENDY SUE GAYLOR-DAVIS LPC

Table of content: MS. WENDY SUE GAYLOR-DAVIS LPC (NPI 1972842102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972842102 NPI number — MS. WENDY SUE GAYLOR-DAVIS LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAYLOR-DAVIS
Provider First Name:
WENDY
Provider Middle Name:
SUE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
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:
1972842102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1633 PHILIPSBURG BIGLER HWY
Provider Second Line Business Mailing Address:
BEHAVIORAL HEALTH DIVISION-CEN CLEAR CHILD SERVICES
Provider Business Mailing Address City Name:
PHILIPSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16866-8112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-342-5678
Provider Business Mailing Address Fax Number:
814-342-0532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
580 OLD ROUTE 322
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILIPSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-342-5678
Provider Business Practice Location Address Fax Number:
814-342-0532
Provider Enumeration Date:
02/07/2013

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:  PC000889 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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