Provider Demographics
NPI:1881167849
Name:DAVIS, HENRY CLAY (LICENSED PROFESSIONA)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:CLAY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 CHIMNEY ROCK DRIVE
Mailing Address - Street 2:APT #1115
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703
Mailing Address - Country:US
Mailing Address - Phone:501-624-7111
Mailing Address - Fax:501-620-5109
Practice Address - Street 1:703 W. PATTEN STREET
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773
Practice Address - Country:US
Practice Address - Phone:903-569-5409
Practice Address - Fax:501-620-5109
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84001101YM0800X
AR106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health