Provider Demographics
NPI:1710971395
Name:DAVIS, GENEVIEVE ANNA (MHC, MFT)
Entity Type:Individual
Prefix:MS
First Name:GENEVIEVE
Middle Name:ANNA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MHC, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5132
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-5132
Mailing Address - Country:US
Mailing Address - Phone:505-983-7105
Mailing Address - Fax:505-473-0818
Practice Address - Street 1:11 CALLE MEDICO STE 5
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4705
Practice Address - Country:US
Practice Address - Phone:505-983-7105
Practice Address - Fax:505-473-0818
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMF0020106H00000X
NMLMFT20106H00000X
NMLMT0813225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM28971884Medicaid