Provider Demographics
NPI:1871997999
Name:DAVIS, JOAN W (LSW)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:W
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 WATERLOO LAKE DR
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-5437
Mailing Address - Country:US
Mailing Address - Phone:903-327-3643
Mailing Address - Fax:580-745-9891
Practice Address - Street 1:804 WATERLOO LAKE DR
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-5437
Practice Address - Country:US
Practice Address - Phone:903-327-3643
Practice Address - Fax:580-745-9891
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK59761101YM0800X
TX597611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health