Provider Demographics
NPI:1124242987
Name:DAVIS, KAREN ANN (PHD, LPC, LM FT)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD, LPC, LM FT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42106 N HOOVER RD
Mailing Address - Street 2:#A
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-4442
Mailing Address - Country:US
Mailing Address - Phone:504-512-5351
Mailing Address - Fax:
Practice Address - Street 1:42106 N HOOVER RD
Practice Address - Street 2:#A
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-4442
Practice Address - Country:US
Practice Address - Phone:504-512-5351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1953101YP2500X
LA446106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist