Provider Demographics
NPI:1093725053
Name:DAVIS, SANDI O (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:SANDI
Middle Name:O
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4859 SHED RD STE 500
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5493
Mailing Address - Country:US
Mailing Address - Phone:318-747-6977
Mailing Address - Fax:318-747-6971
Practice Address - Street 1:4859 SHED RD STE 500
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-5493
Practice Address - Country:US
Practice Address - Phone:318-747-6977
Practice Address - Fax:318-747-6971
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2287101YP2500X
LA538106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
26-2845303OtherTAX ID NUMBER