Provider Demographics
NPI:1174088777
Name:DAVIS, WILLIAM LASLEY (LMHC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LASLEY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2365 S 5900 W
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:UT
Mailing Address - Zip Code:84325-9743
Mailing Address - Country:US
Mailing Address - Phone:360-748-5866
Mailing Address - Fax:
Practice Address - Street 1:2365 S 5900 W
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:UT
Practice Address - Zip Code:84325-9743
Practice Address - Country:US
Practice Address - Phone:360-748-5866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9793823-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional