Individual
RICHARD DAVID DAVIDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LADC, CRC, CVRT,
Contact information
Practice address
3718 S ELM PL, SUITE 3718, BROKEN ARROW, OK 74011-1803
(918) 994-1510
Mailing address
3718 S ELM PL, SUITE 3718, BROKEN ARROW, OK 74011-1803
(918) 994-1510
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TR0400X
Rehabilitation Psychologist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992983407
—
OK
Enumeration date
02/06/2008
Last updated
08/25/2015
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