Provider Demographics
NPI:1811648090
Name:DAVIS, MARIAH CELESTE (MA, LPC)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:CELESTE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:CELESTE
Other - Last Name:DILLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7305 PRIMROSE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-7724
Mailing Address - Country:US
Mailing Address - Phone:806-544-6977
Mailing Address - Fax:
Practice Address - Street 1:6202 IOLA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2728
Practice Address - Country:US
Practice Address - Phone:806-544-6977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76552101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health