Provider Demographics
NPI:1942464904
Name:DAVIS, FRED G SR (LPC)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:G
Last Name:DAVIS
Suffix:SR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WATERFORD PL
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2900
Mailing Address - Country:US
Mailing Address - Phone:601-624-2300
Mailing Address - Fax:601-956-9644
Practice Address - Street 1:431 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39201-1108
Practice Address - Country:US
Practice Address - Phone:601-949-1949
Practice Address - Fax:601-714-6922
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1340106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist