Provider Demographics
NPI:1720156953
Name:DAVIS, KELLY JANE (MA LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JANE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 S CORONA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2717
Mailing Address - Country:US
Mailing Address - Phone:303-722-7572
Mailing Address - Fax:
Practice Address - Street 1:61 W DAVIES AVE N
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5252
Practice Address - Country:US
Practice Address - Phone:303-797-9343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2499101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional