Provider Demographics
NPI:1043794639
Name:DAVIS, BRIDGETT M (QTP, CECP, HMC)
Entity Type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:QTP, CECP, HMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-1725
Mailing Address - Country:US
Mailing Address - Phone:541-207-3773
Mailing Address - Fax:800-549-1017
Practice Address - Street 1:1760 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-1725
Practice Address - Country:US
Practice Address - Phone:541-207-3773
Practice Address - Fax:800-549-1017
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor