Provider Demographics
NPI:1265718076
Name:DAVIS, ROBIN L (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1482 E 3010 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3408
Mailing Address - Country:US
Mailing Address - Phone:385-202-4648
Mailing Address - Fax:801-880-7489
Practice Address - Street 1:1482 E 3010 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3408
Practice Address - Country:US
Practice Address - Phone:385-202-4648
Practice Address - Fax:801-880-7489
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3783283501101YP2500X
UT378328-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional