Provider Demographics
NPI:1578977468
Name:DAVIS PSYCHOLOGICAL HEALTH & WELLNESS PRACTICE, PLLC
Entity Type:Organization
Organization Name:DAVIS PSYCHOLOGICAL HEALTH & WELLNESS PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-241-4954
Mailing Address - Street 1:11703 HUEBNER RD
Mailing Address - Street 2:STE 106-147
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1201
Mailing Address - Country:US
Mailing Address - Phone:210-241-4954
Mailing Address - Fax:210-957-1628
Practice Address - Street 1:1100 NW LOOP 410
Practice Address - Street 2:STE 700
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2263
Practice Address - Country:US
Practice Address - Phone:210-241-4954
Practice Address - Fax:210-957-1628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34154251S00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health