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Individual

JEREMY KEITH DAVIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LPCC, LPC, LADC, SAC

Contact information

Practice address
8200 HUMBOLDT AVE S STE 100, BLOOMINGTON, MN 55431-1433
(952) 454-0421
Mailing address
405 STAGELINE RD, HUDSON, WI 54016-1793
(715) 531-6000

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15822-131
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
305108
MN
101YM0800X
Mental Health Counselor
Primary
2076
MN
101YM0800X
Mental Health Counselor
5690-125
WI

Other

Enumeration date
03/06/2013
Last updated
11/05/2019
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