Provider Demographics
NPI:1245717073
Name:DAVIES, DYLAN (MA, LPC, LMFT)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:DAVIES
Suffix:
Gender:F
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 ELMWOOD PL APT 1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3148
Mailing Address - Country:US
Mailing Address - Phone:210-381-0088
Mailing Address - Fax:
Practice Address - Street 1:1215 PARKWAY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4132
Practice Address - Country:US
Practice Address - Phone:210-381-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76969101YP2500X
TX202767106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist