Provider Demographics
NPI:1205205929
Name:DAVIDSON, DANIEL (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 N MAGDALENA RD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-7802
Mailing Address - Country:US
Mailing Address - Phone:928-699-5902
Mailing Address - Fax:
Practice Address - Street 1:5020 N MAGDALENA RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-7802
Practice Address - Country:US
Practice Address - Phone:928-699-5902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBA-8103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst