Individual
JIM DYLAN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAPRC, CPSP
Contact information
Practice address
914 SOUTH ST, LAFAYETTE, IN 47901-1416
(765) 742-1088
Mailing address
531 DUROC CT APT A, LAFAYETTE, IN 47909-6779
(812) 508-2980
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
IN
Other
Enumeration date
04/28/2025
Last updated
04/28/2025
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