Provider Demographics
NPI:1629118955
Name:DAVIS, EDWARD CLIFTON (EDD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:CLIFTON
Last Name:DAVIS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17330 PRESTON RD
Mailing Address - Street 2:STE 200D
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-6106
Mailing Address - Country:US
Mailing Address - Phone:214-438-3668
Mailing Address - Fax:972-733-6812
Practice Address - Street 1:17330 PRESTON RD
Practice Address - Street 2:STE 200D
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-6106
Practice Address - Country:US
Practice Address - Phone:214-438-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22012103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F10158Medicare PIN