Provider Demographics
NPI:1609931757
Name:DAVIS, MICHAEL LLOYD
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LLOYD
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S FREYA ST
Mailing Address - Street 2:TURQOISE FLAG BLDG, STE 226B
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-4862
Mailing Address - Country:US
Mailing Address - Phone:509-532-1600
Mailing Address - Fax:509-533-1966
Practice Address - Street 1:104 S FREYA ST
Practice Address - Street 2:TURQOISE FLAG BLDG, STE 226B
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-4862
Practice Address - Country:US
Practice Address - Phone:509-532-1600
Practice Address - Fax:509-533-1966
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003714101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health