Provider Demographics
NPI:1437594389
Name:DAVIS, EMMA MAE
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:MAE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 E LAKE MEAD PKWY APT 3119
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-5680
Mailing Address - Country:US
Mailing Address - Phone:702-629-4177
Mailing Address - Fax:
Practice Address - Street 1:7465 W LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1032
Practice Address - Country:US
Practice Address - Phone:702-658-9563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health