Provider Demographics
NPI:1093790586
Name:DAVIDSON, GRACE P (PHD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:P
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 ALMA DR
Mailing Address - Street 2:SUITE 315
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6937
Mailing Address - Country:US
Mailing Address - Phone:972-596-6351
Mailing Address - Fax:972-509-9062
Practice Address - Street 1:1700 ALMA
Practice Address - Street 2:SUITE 315
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6962
Practice Address - Country:US
Practice Address - Phone:972-596-6351
Practice Address - Fax:972-509-9062
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-3603103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83212POtherPARKLAND MEDICARE NUMBER
TX00G80YOtherBLUECROSS BLUESHIELD
TX4343549OtherAETNA
TX00G80YMedicare PIN