Provider Demographics
NPI:1497199459
Name:DAVISON, THOMAS
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:DAVISON
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 1:8873 QUIMPER PL
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5620
Mailing Address - Country:US
Mailing Address - Phone:318-686-0012
Mailing Address - Fax:318-686-0012
Practice Address - Street 1:8873 QUIMPER PL
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5620
Practice Address - Country:US
Practice Address - Phone:318-686-0012
Practice Address - Fax:318-686-0012
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0082561101YM0800X
LA5752101YP2500X
NM0158731101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health