Individual
DR. JERRY EUGENE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2821 HILLEGAS RD, FORT WAYNE, IN 46808-3859
(260) 471-1950
(260) 471-1950
Mailing address
1406 CHERRY ST, HUNTINGTON, IN 46750-1844
(260) 356-1605
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
39000593A
IN
1041C0700X
Clinical Social Worker
Primary
34002606A
IN
106H00000X
Marriage & Family Therapist
35000571A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000183652
ANTHEM BCBS
IN
01
—
7389148
AETNA
IN
Enumeration date
09/22/2006
Last updated
09/11/2025
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