Provider Demographics
NPI:1003182726
Name:DAVIS, MICHELLE LYN
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 S E ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4777
Mailing Address - Country:US
Mailing Address - Phone:707-529-6270
Mailing Address - Fax:
Practice Address - Street 1:144 S E ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4777
Practice Address - Country:US
Practice Address - Phone:707-529-6270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health