Provider Demographics
NPI:1588186290
Name:DAVIS, MARY ANN (BA, ACC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BA, ACC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA, ACC
Mailing Address - Street 1:472 W PASEO RIO GRANDE
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-6877
Mailing Address - Country:US
Mailing Address - Phone:520-425-4034
Mailing Address - Fax:999-999-9999
Practice Address - Street 1:472 W PASEO RIO GRANDE
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-6877
Practice Address - Country:US
Practice Address - Phone:520-425-4034
Practice Address - Fax:999-999-9999
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 221700000X, 171400000X
AZCERTIFICATE101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist