Provider Demographics
NPI:1609422609
Name:DAVIS, MICHAEL BLAKE (LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BLAKE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2849 NIGHTHAWK DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-4966
Mailing Address - Country:US
Mailing Address - Phone:214-587-5789
Mailing Address - Fax:972-222-0520
Practice Address - Street 1:2849 NIGHTHAWK DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-4966
Practice Address - Country:US
Practice Address - Phone:214-587-5789
Practice Address - Fax:972-222-0520
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61946101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health