Provider Demographics
NPI:1518003698
Name:DAVIS, LISA ANN (QMHP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8934 SE RURAL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-5555
Mailing Address - Country:US
Mailing Address - Phone:503-771-8840
Mailing Address - Fax:
Practice Address - Street 1:2034 SE 6TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4510
Practice Address - Country:US
Practice Address - Phone:503-238-6801
Practice Address - Fax:503-238-6810
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health