Provider Demographics
NPI:1811477441
Name:DAVIDSON, JOYCE ELAINE (PHD)
Entity type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:ELAINE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOYCE
Other - Middle Name:ANDERSON
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2515 UNIVERSITY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8628
Mailing Address - Country:US
Mailing Address - Phone:515-451-3895
Mailing Address - Fax:
Practice Address - Street 1:2515 UNIVERSITY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8628
Practice Address - Country:US
Practice Address - Phone:515-451-3895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00962103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling