Provider Demographics
NPI:1922411255
Name:DAVIS, ANN
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFTA
Mailing Address - Street 1:610 BRECKENRIDGE LN
Mailing Address - Street 2:#3
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4541
Mailing Address - Country:US
Mailing Address - Phone:502-894-4496
Mailing Address - Fax:502-479-9868
Practice Address - Street 1:610 BRECKENRIDGE LN
Practice Address - Street 2:#3
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4541
Practice Address - Country:US
Practice Address - Phone:502-894-4496
Practice Address - Fax:502-479-9868
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1113106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist