Provider Demographics
NPI:1457459372
Name:DAVIS, MELANIE LIBRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:LIBRA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10316 OVERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-2653
Mailing Address - Country:US
Mailing Address - Phone:913-381-8090
Mailing Address - Fax:
Practice Address - Street 1:7800 W 110TH ST
Practice Address - Street 2:SUITE 112
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2304
Practice Address - Country:US
Practice Address - Phone:913-345-0033
Practice Address - Fax:913-345-0177
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1132103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical