Provider Demographics
NPI:1922733476
Name:DAVIDSON, MAKAYLA A (LPC)
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:A
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MAKAYLA
Other - Middle Name:A
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 E TWOHIG AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-6433
Mailing Address - Country:US
Mailing Address - Phone:325-944-2561
Mailing Address - Fax:325-653-4218
Practice Address - Street 1:36 E TWOHIG AVE STE 600
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-6433
Practice Address - Country:US
Practice Address - Phone:325-944-2561
Practice Address - Fax:325-653-4218
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86051OtherLICENSE