Provider Demographics
NPI:1851861132
Name:DAVIS, OLETA (MED)
Entity Type:Individual
Prefix:MS
First Name:OLETA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3913
Mailing Address - Country:US
Mailing Address - Phone:985-241-5448
Mailing Address - Fax:985-735-6744
Practice Address - Street 1:537 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3913
Practice Address - Country:US
Practice Address - Phone:985-241-5448
Practice Address - Fax:985-735-6744
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty