Provider Demographics
NPI:1215568944
Name:DAVIS, LISA H
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:H
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21448 N 75TH AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5978
Mailing Address - Country:US
Mailing Address - Phone:623-572-8053
Mailing Address - Fax:
Practice Address - Street 1:21448 N 75TH AVE STE 6
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5978
Practice Address - Country:US
Practice Address - Phone:623-572-8053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor