Provider Demographics
NPI:1235316456
Name:DAVIS, SCOTT EUGENE (LPC-I)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:EUGENE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 BERRY DOWN LN APT 11106
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-6171
Mailing Address - Country:US
Mailing Address - Phone:940-367-6728
Mailing Address - Fax:
Practice Address - Street 1:4141 BLUE LAKE CIR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5132
Practice Address - Country:US
Practice Address - Phone:972-387-3896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63481101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)