Provider Demographics
NPI:1659333987
Name:DAVIS, TERASA LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TERASA
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 HELEN KELLER BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-2964
Mailing Address - Country:US
Mailing Address - Phone:205-391-9777
Mailing Address - Fax:205-391-9766
Practice Address - Street 1:661 HELEN KELLER BLVD STE B
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2964
Practice Address - Country:US
Practice Address - Phone:205-391-9777
Practice Address - Fax:205-391-9766
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL906103TC0700X
AL#906103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-23502OtherBCBS
AL890010770Medicaid
AL515-23502OtherBCBS
AL051554352DAVMedicare ID - Type Unspecified