Provider Demographics
NPI:1407125081
Name:DAVIS, TONYA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S WIESBROOK RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-7813
Mailing Address - Country:US
Mailing Address - Phone:630-260-8780
Mailing Address - Fax:
Practice Address - Street 1:2001 S WIESBROOK RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-7813
Practice Address - Country:US
Practice Address - Phone:630-260-8780
Practice Address - Fax:630-938-4687
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178006688101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional