Provider Demographics
NPI:1073501631
Name:DAVIDSON, KEVIN PATRICK (LPC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:PATRICK
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 E BRANCH HOLLOW DR APT 385
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-1091
Mailing Address - Country:US
Mailing Address - Phone:972-786-1701
Mailing Address - Fax:
Practice Address - Street 1:203 N JACKSON AVE
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4444
Practice Address - Country:US
Practice Address - Phone:972-442-7770
Practice Address - Fax:972-442-7771
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRS141297101YP2500X
TX66038101YP2500X
OHE.00007850101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional