Provider Demographics
NPI:1003034695
Name:DAVIS, DEBORAH SUE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:SUE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1283
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-1283
Mailing Address - Country:US
Mailing Address - Phone:214-325-2049
Mailing Address - Fax:972-636-3825
Practice Address - Street 1:8042 BERRY CT
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-7836
Practice Address - Country:US
Practice Address - Phone:214-325-2049
Practice Address - Fax:972-636-3825
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
TX40444104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1808388-02Medicare UPIN
TX1808388Medicare UPIN