Provider Demographics
NPI:1679298855
Name:DAVIS, SIERRA (MS, PCMHT)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, PCMHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 COUNTY ROAD 710
Mailing Address - Street 2:
Mailing Address - City:BLUE MOUNTAIN
Mailing Address - State:MS
Mailing Address - Zip Code:38610-9550
Mailing Address - Country:US
Mailing Address - Phone:662-388-1663
Mailing Address - Fax:
Practice Address - Street 1:101 CUNNINGHAM DR
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-1302
Practice Address - Country:US
Practice Address - Phone:662-837-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
459OtherISSUER NUMBER