Provider Demographics
NPI:1770031007
Name:DAVIS, JACOBI CORRELL (MHS)
Entity Type:Individual
Prefix:
First Name:JACOBI
Middle Name:CORRELL
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7007 BOBTAIL DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-3417
Mailing Address - Country:US
Mailing Address - Phone:318-364-7766
Mailing Address - Fax:
Practice Address - Street 1:7007 BOBTAIL DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-3417
Practice Address - Country:US
Practice Address - Phone:318-364-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor