Provider Demographics
NPI:1396854154
Name:DAVIS, BARBARA LEE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:LEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W AVENUE K
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-8307
Mailing Address - Country:US
Mailing Address - Phone:817-683-1610
Mailing Address - Fax:
Practice Address - Street 1:3109 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5742
Practice Address - Country:US
Practice Address - Phone:817-683-1610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX364191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J3319Medicare PIN