Individual
MATTHEW AARON CODY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1405 E BURNETT AVE, LOUISVILLE, KY 40217-1577
(502) 350-0575
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
262369
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100731310
—
KY
01
—
K377650
KENTUCKY MEDICARE
KY
Enumeration date
03/19/2021
Last updated
12/06/2024
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