Provider Demographics
NPI:1740672302
Name:DAVIS, JESSICA KATE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KATE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6034 HEATH VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4352
Mailing Address - Country:US
Mailing Address - Phone:317-249-2242
Mailing Address - Fax:
Practice Address - Street 1:12650 HAMILTON CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5400
Practice Address - Country:US
Practice Address - Phone:317-249-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-14-17171103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst