Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 6401009811 | MI |
NPI | 1003241589 |
---|---|
Provider Name | Mrs. Stacey A Davis |
First Address | Plainwell, MI 49080-1644 |
Second Address | Plainwell, MI 49080-1644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2013 |
Last Update Date | 04/09/2013 |