Provider Demographics
NPI:1245380732
Name:DAVIS, HOWARD ALBERT (LISW, LCSW, MPA)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:ALBERT
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LISW, LCSW, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 TERRELL AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-1109
Mailing Address - Country:US
Mailing Address - Phone:406-202-5030
Mailing Address - Fax:877-606-9254
Practice Address - Street 1:9611 ACER AVE STE 108
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-6719
Practice Address - Country:US
Practice Address - Phone:406-202-5030
Practice Address - Fax:915-307-7475
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI057931041C0700X
MT9591041C0700X
TX574031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT70368OtherBLUE CROSS BLUE SHIELD