Provider Demographics
NPI:1013491653
Name:DAVIS, GENEVIEVE BLAYEE (BEHAVIORAL TECH)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:BLAYEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BEHAVIORAL TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1184 W PIONEER PKWY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-6367
Mailing Address - Country:US
Mailing Address - Phone:168-230-8083
Mailing Address - Fax:682-308-0835
Practice Address - Street 1:1184 W PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6367
Practice Address - Country:US
Practice Address - Phone:168-230-8083
Practice Address - Fax:682-308-0835
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician