Provider Demographics
NPI:1346454766
Name:DAVISSON, EDWARD A (LPC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:A
Last Name:DAVISSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 GASTON AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-6404
Mailing Address - Country:US
Mailing Address - Phone:469-583-6441
Mailing Address - Fax:
Practice Address - Street 1:6162 E MOCKINGBIRD LN
Practice Address - Street 2:220
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2697
Practice Address - Country:US
Practice Address - Phone:469-583-6441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16189101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional