Provider Demographics
NPI:1750555876
Name:DAVIS, DEENA RAE (MA, LPC)
Entity type:Individual
Prefix:
First Name:DEENA
Middle Name:RAE
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 1:2665 FM 636
Mailing Address - Street 2:
Mailing Address - City:KERENS
Mailing Address - State:TX
Mailing Address - Zip Code:75144-4053
Mailing Address - Country:US
Mailing Address - Phone:903-396-2627
Mailing Address - Fax:
Practice Address - Street 1:2665 FM 636
Practice Address - Street 2:
Practice Address - City:KERENS
Practice Address - State:TX
Practice Address - Zip Code:75144-4053
Practice Address - Country:US
Practice Address - Phone:903-396-2627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62247101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional