Provider Demographics
NPI:1942977350
Name:DAVIS, LYNDSIE NICOLE (MED, LPC, CAT, NCC)
Entity Type:Individual
Prefix:MS
First Name:LYNDSIE
Middle Name:NICOLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MED, LPC, CAT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PEYTON CV
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-9507
Mailing Address - Country:US
Mailing Address - Phone:662-397-7170
Mailing Address - Fax:
Practice Address - Street 1:202 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-2761
Practice Address - Country:US
Practice Address - Phone:662-371-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2705101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty