Provider Demographics
NPI:1134274442
Name:DAVIS, PATTI-JO (RNP, LPC)
Entity type:Individual
Prefix:
First Name:PATTI-JO
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RNP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 S MILL AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-6757
Mailing Address - Country:US
Mailing Address - Phone:480-345-1200
Mailing Address - Fax:480-345-1281
Practice Address - Street 1:4600 S MILL AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6757
Practice Address - Country:US
Practice Address - Phone:480-345-1200
Practice Address - Fax:480-345-1281
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC0880101YM0800X
AZRN036338163WP0808X
AZAP060363LP0808X
AZAP0032364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
S48367Medicare UPIN