Provider Demographics
NPI:1639447113
Name:DAVIDSON COUNSELING GROUP PC
Entity Type:Organization
Organization Name:DAVIDSON COUNSELING GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-251-9615
Mailing Address - Street 1:3500 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-6017
Mailing Address - Country:US
Mailing Address - Phone:972-251-9615
Mailing Address - Fax:877-581-3908
Practice Address - Street 1:7800 PRESTON RD STE 145
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3239
Practice Address - Country:US
Practice Address - Phone:972-251-9615
Practice Address - Fax:877-581-3908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36018103TC0700X
TX36019103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DACP07702Medicare PIN
DACP15801Medicare PIN