Provider Demographics
NPI:1881813327
Name:DAVIS, JANNETTE (MS, CST)
Entity type:Individual
Prefix:
First Name:JANNETTE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 FARNAM ST STE 204
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-1885
Mailing Address - Country:US
Mailing Address - Phone:402-341-2230
Mailing Address - Fax:
Practice Address - Street 1:1004 FARNAM ST STE 204
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-1885
Practice Address - Country:US
Practice Address - Phone:402-341-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE291106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84398OtherBCBS PROVIDER NUMBER