Provider Demographics
NPI:1619294014
Name:DAVIS, RICHARD FREDRICK (LPC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:FREDRICK
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9612 GOLDEN WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:ID
Mailing Address - Zip Code:83644-5287
Mailing Address - Country:US
Mailing Address - Phone:208-585-2707
Mailing Address - Fax:208-585-2707
Practice Address - Street 1:1031 W SANETTA ST
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-5047
Practice Address - Country:US
Practice Address - Phone:208-466-7443
Practice Address - Fax:208-466-7443
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor