Provider Demographics
NPI:1063821460
Name:DAVIS, JASON (MS, LPC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9595 SIX PINES DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1531
Mailing Address - Country:US
Mailing Address - Phone:936-697-2822
Mailing Address - Fax:832-631-6266
Practice Address - Street 1:9595 SIX PINES DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1531
Practice Address - Country:US
Practice Address - Phone:281-763-0592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68030101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional