Provider Demographics
NPI:1417354002
Name:DAVIS, DARMAINE
Entity Type:Individual
Prefix:
First Name:DARMAINE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 SAN JUAN TRL
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2163
Mailing Address - Country:US
Mailing Address - Phone:405-830-4279
Mailing Address - Fax:
Practice Address - Street 1:2908 SAN JUAN TRL
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2163
Practice Address - Country:US
Practice Address - Phone:405-830-4279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health