Provider Demographics
NPI:1568908465
Name:DAVIS, AMY MACKENZIE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MACKENZIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10260 NW 48TH CT
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-1717
Mailing Address - Country:US
Mailing Address - Phone:954-397-0464
Mailing Address - Fax:
Practice Address - Street 1:10260 NW 48TH CT
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-1717
Practice Address - Country:US
Practice Address - Phone:954-397-0464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician