Basic Information
| Provider Information | |||||||||
| NPI: | 1851632277 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MSCP, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1939 KIPLING AVE | ||||||||
| Address2: | |||||||||
| City: | BERKLEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480721519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486757748 | ||||||||
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| Practice Location | |||||||||
| Address1: | 89 W SOUTH BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006931916 | ||||||||
| FaxNumber: | 2486931916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2013 | ||||||||
| LastUpdateDate: | 10/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 6301015074 | MI | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | 6361005093 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.