Provider Demographics
NPI:1376825133
Name:DAVIS, DANIEL G (PSYD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 S BAILEY ST STE 104
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6360
Mailing Address - Country:US
Mailing Address - Phone:907-746-3337
Mailing Address - Fax:907-746-3336
Practice Address - Street 1:634 S BAILEY ST STE 104
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6360
Practice Address - Country:US
Practice Address - Phone:907-746-3337
Practice Address - Fax:907-746-3336
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AK135955103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health