Provider Demographics
NPI:1669987897
Name:KATHY L. DAVIES LPC PLLC
Entity type:Organization
Organization Name:KATHY L. DAVIES LPC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-658-5272
Mailing Address - Street 1:33170 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-7868
Mailing Address - Country:US
Mailing Address - Phone:918-658-5272
Mailing Address - Fax:
Practice Address - Street 1:1301 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-5206
Practice Address - Country:US
Practice Address - Phone:918-658-5272
Practice Address - Fax:918-658-5272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5767261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)