Individual
JERRY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMHC
Contact information
Practice address
1530 COMMERCE PARK WEST DRIVE, GREENSBURG, IN 47240
(812) 663-7057
(812) 378-8367
Mailing address
720 N MARR RD, COLUMBUS, IN 47201-6660
(812) 314-3400
(812) 378-8367
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39001542A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000321018
ANTHEM PIN
IN
Enumeration date
02/02/2006
Last updated
04/03/2024
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