Provider Demographics
NPI:1487050639
Name:DAVIS, AMANDA VICTORIA (DPC, LPC)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:VICTORIA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DPC, LPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:VICTORIA
Other - Last Name:ELAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3450 HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-7201
Mailing Address - Country:US
Mailing Address - Phone:601-321-2400
Mailing Address - Fax:601-321-2476
Practice Address - Street 1:633 E FERNHURST DR STE 1304
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1590
Practice Address - Country:US
Practice Address - Phone:281-503-1553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84301101YM0800X
MSPH3036101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health