Provider Demographics
NPI:1023503364
Name:DAVIS, BRANDON JAMES (LMFT)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:JAMES
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 N PINE GROVE CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-5019
Mailing Address - Country:US
Mailing Address - Phone:316-655-1039
Mailing Address - Fax:
Practice Address - Street 1:2017 N PINE GROVE CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-5019
Practice Address - Country:US
Practice Address - Phone:316-655-1039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist