Provider Demographics
NPI:1750542460
Name:DAVIS, MARK ALAN SR (MA, MFT, TS,)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALAN
Last Name:DAVIS
Suffix:SR
Gender:M
Credentials:MA, MFT, TS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 BRYN MAWR AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1806
Mailing Address - Country:US
Mailing Address - Phone:484-626-6016
Mailing Address - Fax:
Practice Address - Street 1:147 BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-1806
Practice Address - Country:US
Practice Address - Phone:484-626-6016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health