Provider Demographics
NPI:1851725055
Name:DAVIS, SAVANNAH MARIE
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 NE WILLIAMSON CT STE B
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3941
Mailing Address - Country:US
Mailing Address - Phone:541-837-6901
Mailing Address - Fax:
Practice Address - Street 1:2041 NE WILLIAMSON CT STE B
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3941
Practice Address - Country:US
Practice Address - Phone:541-837-6901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-25
Last Update Date:2023-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ORL10425101YM0800X
ORA46791041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical