Provider Demographics
NPI:1508377573
Name:DAVIS, ELIZABETH CHELSEA (RBAI)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CHELSEA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RBAI
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:CHELSEA
Other - Last Name:DAVIS-LAURIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 82819
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97282-0819
Mailing Address - Country:US
Mailing Address - Phone:503-612-1000
Mailing Address - Fax:
Practice Address - Street 1:18765 SW BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8496
Practice Address - Country:US
Practice Address - Phone:503-612-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst