Provider Demographics
NPI:1326169236
Name:DAVIS, CAROLYN ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10707 CORPORATE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4095
Mailing Address - Country:US
Mailing Address - Phone:281-240-9797
Mailing Address - Fax:
Practice Address - Street 1:10707 CORPORATE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4095
Practice Address - Country:US
Practice Address - Phone:281-240-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23664103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00D63BMedicare ID - Type Unspecified