Provider Demographics
NPI:1982692497
Name:DAVIDSON-METHOT, DAVID GLENN (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GLENN
Last Name:DAVIDSON-METHOT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:GLENN
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 S VAL VISTA DR
Mailing Address - Street 2:SUITE A3, #477
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1375
Mailing Address - Country:US
Mailing Address - Phone:480-262-0326
Mailing Address - Fax:480-813-2706
Practice Address - Street 1:33 N LINDSAY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5807
Practice Address - Country:US
Practice Address - Phone:480-262-0326
Practice Address - Fax:480-813-2706
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3732103TC0700X
CA18748103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP76954Medicare UPIN
AZ107509Medicare PIN