Provider Demographics
NPI:1922234061
Name:DAVIS, BEAU D (MMFT LMFT)
Entity Type:Individual
Prefix:
First Name:BEAU
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MMFT LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 S I-35 E
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-4101
Mailing Address - Country:US
Mailing Address - Phone:940-483-1789
Mailing Address - Fax:
Practice Address - Street 1:723 S I-35 E
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-4101
Practice Address - Country:US
Practice Address - Phone:940-483-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
TX201168106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral