Provider Demographics
NPI:1134628423
Name:DAVIS, KATHRYN D (LPC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:D
Other - Last Name:FREEMAN; LASHLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1413 S 237TH LN
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-3616
Mailing Address - Country:US
Mailing Address - Phone:602-301-4647
Mailing Address - Fax:
Practice Address - Street 1:5060 N 19TH AVE STE 218
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3212
Practice Address - Country:US
Practice Address - Phone:602-750-6043
Practice Address - Fax:623-433-0786
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17553101YP2500X
AZLAC-15493101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)