Individual
MR. GARY S DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504-0649
(928) 729-3741
(928) 729-8943
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649
(928) 729-3741
(928) 729-8943
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
303490
NM
221700000X
Art Therapist
Primary
303490
NM
Other
Enumeration date
06/23/2011
Last updated
07/11/2011
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