Provider Demographics
NPI:1326336819
Name:DAVIS, BRENDA LEE (LMSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-0189
Mailing Address - Country:US
Mailing Address - Phone:573-265-3251
Mailing Address - Fax:
Practice Address - Street 1:13160 COUNTY ROAD 3610
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-9700
Practice Address - Country:US
Practice Address - Phone:573-265-3251
Practice Address - Fax:573-265-0156
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011012553104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker