Provider Demographics
NPI:1215574611
Name:DAVIS, TEVIN D (LPC)
Entity Type:Individual
Prefix:
First Name:TEVIN
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5061 S 136TH EAST AVE APT 311
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-7015
Mailing Address - Country:US
Mailing Address - Phone:918-978-1880
Mailing Address - Fax:
Practice Address - Street 1:5061 S 136TH EAST AVE APT 311
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-7015
Practice Address - Country:US
Practice Address - Phone:918-978-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10954101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional