Provider Demographics
NPI:1972992592
Name:DAVIS, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 WERNER CT
Mailing Address - Street 2:STE. 395
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1303
Mailing Address - Country:US
Mailing Address - Phone:307-472-5227
Mailing Address - Fax:
Practice Address - Street 1:951 WERNER CT
Practice Address - Street 2:STE. 395
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1303
Practice Address - Country:US
Practice Address - Phone:307-472-5227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker