Organization
PROFESSIONAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L DAVIS MSW, LCSW (OWNER)
(573) 584-0158
Entity
Organization
Contact information
Practice address
1115 HERMITS LN, JEFFERSON CITY, MO 65109-3239
(573) 584-0158
(573) 584-0169
Mailing address
PO BOX 6880, JEFFERSON CITY, MO 65102-6880
(573) 584-0158
(573) 584-0159
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
2002006736
MO
103TC0700X
Clinical Psychologist
01459
MO
1041C0700X
Clinical Social Worker
Primary
000949
MO
1041C0700X
Clinical Social Worker
2008019098
MO
Other
Enumeration date
02/26/2009
Last updated
02/26/2009
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