Provider Demographics
NPI:1619082039
Name:DAVIS, DAVID P (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7195 W FALCON VIEW PASS
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-4986
Mailing Address - Country:US
Mailing Address - Phone:808-756-1863
Mailing Address - Fax:520-352-9602
Practice Address - Street 1:7195 W FALCON VIEW PASS
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85658-4986
Practice Address - Country:US
Practice Address - Phone:808-756-1863
Practice Address - Fax:820-352-9602
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 212103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487760484OtherGROUP NPI FOR DAVID P DAVIS, PH.D., LLC
HI047310Medicaid