Provider Demographics
NPI:1326197922
Name:DAVIS, MICHELLE ANDERSON (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANDERSON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-1040
Mailing Address - Country:US
Mailing Address - Phone:254-752-9330
Mailing Address - Fax:254-752-9655
Practice Address - Street 1:2323 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1040
Practice Address - Country:US
Practice Address - Phone:254-752-9330
Practice Address - Fax:254-752-9655
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16172101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional