Provider Demographics
NPI:1023255437
Name:DAVIS, BILLIE JO (PHD, BCBA)
Entity type:Individual
Prefix:DR
First Name:BILLIE
Middle Name:JO
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 IRONWOOD DR. SUITE D
Mailing Address - Street 2:PMD 106
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815
Mailing Address - Country:US
Mailing Address - Phone:208-699-2595
Mailing Address - Fax:
Practice Address - Street 1:21 IRONWOOD DR.
Practice Address - Street 2:SUITE D PMD 106
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815
Practice Address - Country:US
Practice Address - Phone:208-699-2595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60063071101YM0800X
FL1000013103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst