Provider Demographics
NPI:1881880003
Name:DAVIS, CHAD ALAN
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:ALAN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 W BROADWAY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-2604
Mailing Address - Country:US
Mailing Address - Phone:509-764-4164
Mailing Address - Fax:509-764-4165
Practice Address - Street 1:1021 W BROADWAY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2604
Practice Address - Country:US
Practice Address - Phone:509-764-4164
Practice Address - Fax:509-764-4165
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60071760101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health