Provider Demographics
NPI:1255372843
Name:DAVIS, DEBRA L (LCSW)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1970 RAWHIDE DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-6957
Mailing Address - Country:US
Mailing Address - Phone:512-244-7271
Mailing Address - Fax:512-238-6348
Practice Address - Street 1:1970 RAWHIDE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-6957
Practice Address - Country:US
Practice Address - Phone:512-244-7271
Practice Address - Fax:512-238-6348
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX293401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0072LJOtherBCBS PROVIDER NO.
TX0072LJOtherBCBS PROVIDER NO.