Provider Demographics
NPI:1922252493
Name:DAVIDSON, MARY MEGHAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:MEGHAN
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:114 TEACHERS COLLEGE HALL
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68588-0345
Mailing Address - Country:US
Mailing Address - Phone:402-472-1482
Mailing Address - Fax:402-472-8319
Practice Address - Street 1:114 TEACHERS COLLEGE HALL
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68588-0345
Practice Address - Country:US
Practice Address - Phone:402-472-1482
Practice Address - Fax:402-472-8319
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE687103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE08218OtherBLUE CROSS BLUE SHIELD OF NEBRASKA