Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | IL |
NPI | 1215123104 |
---|---|
Provider Name | Ms. Mary Lynn Davis |
First Address | Westchester, IL 60154-4358 |
Second Address | Westchester, IL 60154 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2007 |
Last Update Date | 15/05/2013 |