Provider Demographics
NPI:1366629115
Name:DAVIS, ALLISON J (MA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5764 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5427
Mailing Address - Country:US
Mailing Address - Phone:915-204-4089
Mailing Address - Fax:877-606-9254
Practice Address - Street 1:5764 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5427
Practice Address - Country:US
Practice Address - Phone:915-204-4089
Practice Address - Fax:877-606-9254
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61616101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190323902Medicaid