Provider Demographics
NPI:1356956551
Name:DAVIS, TIM (QBHP)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:QBHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 CENTRAL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS NATIONAL PARK
Mailing Address - State:AR
Mailing Address - Zip Code:71913-7204
Mailing Address - Country:US
Mailing Address - Phone:501-463-4348
Mailing Address - Fax:
Practice Address - Street 1:4328 CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS NATIONAL PARK
Practice Address - State:AR
Practice Address - Zip Code:71913-7204
Practice Address - Country:US
Practice Address - Phone:501-463-4348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician