Provider Demographics
NPI:1710505417
Name:DAVIS, ADAM (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6343 W 120TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-3701
Mailing Address - Country:US
Mailing Address - Phone:720-380-3564
Mailing Address - Fax:
Practice Address - Street 1:950 S CHERRY ST STE 1675
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-2532
Practice Address - Country:US
Practice Address - Phone:720-380-3564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000210346Medicaid