Provider Demographics
NPI:1396232716
Name:DAVIS, MARILYN D (PSYD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PSYD, LMFT
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 332081
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37133-2081
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2615 MEDICAL CENTER PKWY STE 1560
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3758
Practice Address - Country:US
Practice Address - Phone:615-749-9781
Practice Address - Fax:615-807-3715
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108737106H00000X
TN1559106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist