Provider Demographics
NPI:1154463784
Name:DAVIS, ELICIA MERRIL (MHR)
Entity Type:Individual
Prefix:MS
First Name:ELICIA
Middle Name:MERRIL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MHR
Other - Prefix:MISS
Other - First Name:ELICIA
Other - Middle Name:MERRIL
Other - Last Name:FUQUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:650 S PEORIA
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-4429
Mailing Address - Country:US
Mailing Address - Phone:918-587-9471
Mailing Address - Fax:918-650-0137
Practice Address - Street 1:650 S PEORIA
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-4429
Practice Address - Country:US
Practice Address - Phone:918-587-9471
Practice Address - Fax:918-650-0137
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor