Provider Demographics
NPI:1497166854
Name:DAVIS, EDWARD BRITT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BRITT
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:WARD
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:111 N WHEATON AVE UNIT 210
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5193
Mailing Address - Country:US
Mailing Address - Phone:919-605-6190
Mailing Address - Fax:630-752-7033
Practice Address - Street 1:7 BLANCHARD CIR
Practice Address - Street 2:SUITE #201
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-2037
Practice Address - Country:US
Practice Address - Phone:630-653-2300
Practice Address - Fax:630-653-2895
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008813103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical