Provider Demographics
NPI:1033614599
Name:MONROE, DAVIDSON C (LPC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:DAVIDSON
Middle Name:C
Last Name:MONROE
Suffix:
Gender:M
Credentials:LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 JOAN
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:OK
Mailing Address - Zip Code:73084-4653
Mailing Address - Country:US
Mailing Address - Phone:405-471-3114
Mailing Address - Fax:
Practice Address - Street 1:425 S FRETZ AVE STE C
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-5568
Practice Address - Country:US
Practice Address - Phone:405-726-9808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health