Provider Demographics
NPI:1073717872
Name:DAVIS, MIRIAM R (MS, MED, LMHC)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 PALM BEACH LAKES BLVD.
Mailing Address - Street 2:SUITE 300P
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6515
Mailing Address - Country:US
Mailing Address - Phone:561-253-0530
Mailing Address - Fax:561-697-0004
Practice Address - Street 1:2001 PALM BEACH LAKES BLVD.
Practice Address - Street 2:SUITE 300P
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6515
Practice Address - Country:US
Practice Address - Phone:561-253-0530
Practice Address - Fax:561-697-0004
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 784101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health