Provider Demographics
NPI:1801232889
Name:DAVY, DANIEL GLENN (QMHA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:GLENN
Last Name:DAVY
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-3422
Mailing Address - Country:US
Mailing Address - Phone:541-756-2057
Mailing Address - Fax:
Practice Address - Street 1:1840 UNION AVE
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-3422
Practice Address - Country:US
Practice Address - Phone:541-756-2057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator