Provider Demographics
NPI:1720597941
Name:DAVIS, TREVER D (DBH, LAC)
Entity Type:Individual
Prefix:
First Name:TREVER
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DBH, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 ALFONSE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:86324-7402
Mailing Address - Country:US
Mailing Address - Phone:928-458-6198
Mailing Address - Fax:
Practice Address - Street 1:771 ALFONSE RD
Practice Address - Street 2:
Practice Address - City:CLARKDALE
Practice Address - State:AZ
Practice Address - Zip Code:86324-7402
Practice Address - Country:US
Practice Address - Phone:928-458-6198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-13121101YA0400X, 101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health