Provider Demographics
NPI:1578215018
Name:DAVIS, JOANNE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 S 75TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-7720
Mailing Address - Country:US
Mailing Address - Phone:918-510-7502
Mailing Address - Fax:
Practice Address - Street 1:1724 S 75TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-7720
Practice Address - Country:US
Practice Address - Phone:918-510-7502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist