Provider Demographics
NPI:1811214158
Name:DAVIS, ELIZABETH HELEN (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:HELEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:DAVIS
Other - Last Name:DAVIS GOLDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:140 PROSPECT AVE STE N
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6074
Mailing Address - Country:US
Mailing Address - Phone:314-884-0808
Mailing Address - Fax:314-899-5799
Practice Address - Street 1:140 PROSPECT AVE STE N
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6074
Practice Address - Country:US
Practice Address - Phone:314-884-0808
Practice Address - Fax:314-899-5799
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010009570103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2010009570OtherMISSOURI PSYCHOLOGY LICENSE