Provider Demographics
NPI:1831345883
Name:DAVIS, ALEXA DALE (PHD)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:DALE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DALE
Other - Middle Name:DAVIS
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4253 N CROSSOVER RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4593
Mailing Address - Country:US
Mailing Address - Phone:479-521-5731
Mailing Address - Fax:479-521-6520
Practice Address - Street 1:702 N MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2900
Practice Address - Country:US
Practice Address - Phone:870-741-2658
Practice Address - Fax:870-741-2722
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR08-11P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist