Individual
MR. KENNETH LEE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPSW, CPSC, MSD, DD
Contact information
Practice address
184 UNSER BLVD NE, RIO RANCHO, NM 87124-4045
(505) 896-0928
(504) 994-0209
Mailing address
177B EL CERRO MISSION RD, LOS LUNAS, NM 87031-7874
(505) 240-2399
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
RC00056544
WA
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44842
—
NM
Enumeration date
02/22/2007
Last updated
04/25/2014
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