Provider Demographics
NPI:1821770421
Name:CODY W DAVIS, PA
Entity type:Organization
Organization Name:CODY W DAVIS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:479-453-6287
Mailing Address - Street 1:12020 DELANEY CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-0009
Mailing Address - Country:US
Mailing Address - Phone:479-453-6287
Mailing Address - Fax:479-228-5216
Practice Address - Street 1:5 W MOUNTAIN ST STE 305
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-6068
Practice Address - Country:US
Practice Address - Phone:479-453-6287
Practice Address - Fax:479-228-5216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty