Provider Demographics
NPI:1275967796
Name:DAVIS, MCKAY KNIGHT (MACL, LPC, CRADC)
Entity Type:Individual
Prefix:
First Name:MCKAY
Middle Name:KNIGHT
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MACL, LPC, CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:689 W JUAN TABO LN
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-1487
Mailing Address - Country:US
Mailing Address - Phone:417-838-7105
Mailing Address - Fax:
Practice Address - Street 1:689 W JUAN TABO LN
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1487
Practice Address - Country:US
Practice Address - Phone:417-838-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO8056101YA0400X
MO2013022743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)