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Provider Information for 1801373550


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JACQUELINE DAVIS LMHC


Sex: Female

NPI: 1801373550
Last Updated: 2019-01-15
Certification Date:

Details

NameValue
NPI1801373550
Enumeration Date2018-07-25
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 1380 SW SWANTOWN AVE APT G
OAK HARBOR, WA 98277-7523
United States

Phone: 509-216-3195 | Fax:
 
Primary Practice Address 1380 SW SWANTOWN AVE APT G
OAK HARBOR, WA 98277-7523
United States

Phone: 509-216-3195 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental HealthWALH00007377