Individual
JERRY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1150 GRAHAM RD STE 102, FLORISSANT, MO 63031-8077
(314) 285-4733
Mailing address
1430 OLIVE ST STE 400, SAINT LOUIS, MO 63103-2303
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
07/12/2016
Last updated
03/16/2022
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