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Individual

MR. PHILLIP LEE DAVIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
NCC, LMHC

Contact information

Practice address
120 N HIGHWAY 1, BIRMINGHAM, IA 52535-7700
(641) 455-0636
(319) 498-4246
Mailing address
18219 150TH ST, DOUDS, IA 52551-8036
(641) 919-3465

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
00116
IA
101YM0800X
Mental Health Counselor
Primary
001316
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
12837
IA
Enumeration date
01/31/2011
Last updated
03/17/2018
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