Provider Demographics
NPI:1508346131
Name:DAVIS, STEPHANIE (MS, MED)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, MED
Other - Prefix:MS
Other - First Name:STEPANIE
Other - Middle Name:
Other - Last Name:GLOVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, MED
Mailing Address - Street 1:6508 HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-8751
Mailing Address - Country:US
Mailing Address - Phone:310-413-6834
Mailing Address - Fax:
Practice Address - Street 1:3018 OLD MINDEN RD STE 1117
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2497
Practice Address - Country:US
Practice Address - Phone:318-746-1935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health