Individual
MRS. LILLIAN M DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
1736 E SUNSHINE ST, SPRINGFIELD, MO 65804-1343
(417) 414-0405
Mailing address
1125 E CHARLES ST, REPUBLIC, MO 65738-2616
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
201-300-5501
MO
Other
Enumeration date
03/07/2018
Last updated
03/07/2018
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