Provider Demographics
NPI:1619487386
Name:DAVIS, JOHN E (MA CAC II)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MA CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 SHAFFER PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-4108
Mailing Address - Country:US
Mailing Address - Phone:720-922-9779
Mailing Address - Fax:
Practice Address - Street 1:8101 SHAFFER PKWY STE 102
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-4108
Practice Address - Country:US
Practice Address - Phone:720-922-9779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103TC1900X
CO0005534101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling