Provider Demographics
NPI:1033159199
Name:DAVIS, HENRY S (PHD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:S
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 S VIRGINIA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-3692
Mailing Address - Country:US
Mailing Address - Phone:270-889-9200
Mailing Address - Fax:270-889-9911
Practice Address - Street 1:1910 S VIRGINIA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-3692
Practice Address - Country:US
Practice Address - Phone:270-889-9200
Practice Address - Fax:270-889-9911
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0293103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7384130OtherAETNA PROVIDER NUMBER
KY1169391OtherCHA PROVIDER NUMBER
KY6107168OtherUBH PROVIDER NUMBER
LA000000211006OtherANTHEM PROVIDER NUMBER
LAS85545Medicare UPIN
KY0695501Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER