Provider Demographics
NPI:1366005027
Name:IRMA D DAVIS LMFT
Entity Type:Organization
Organization Name:IRMA D DAVIS LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:812-249-3620
Mailing Address - Street 1:1400 SOUTH PUGH DRIVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802
Mailing Address - Country:US
Mailing Address - Phone:812-249-3620
Mailing Address - Fax:
Practice Address - Street 1:1400 SOUTH PUGH DRIVE
Practice Address - Street 2:SUITE #3
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802
Practice Address - Country:US
Practice Address - Phone:812-249-3620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN35001703AOtherPROFESSIONAL LICENSING