Individual
KATHLEEN MARIE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
601 E CENTER ST, SALEM, MO 65560-1705
(573) 247-0558
(573) 739-1157
Mailing address
12180 W. 32 HWY, SALEM, MO 65560
(573) 247-0558
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2010004342
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2010004342
LICENSED PROFESSIONAL COUNSELOR
MO
Enumeration date
01/18/2012
Last updated
02/20/2015
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