Individual
JESSICA DAVIDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC, ATR
Contact information
Practice address
14426 S OUTER 40 RD, TOWN AND COUNTRY, MO 63017-5711
(636) 224-1300
Mailing address
14426 S OUTER 40 RD, TOWN AND COUNTRY, MO 63017-5711
(636) 224-1300
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
180008597
IL
101YP2500X
Professional Counselor
Primary
2008027607
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13545669
CAQH
—
Enumeration date
04/28/2016
Last updated
11/19/2016
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