| Jody Davidson Llc | |
|
315 Alamo St Lake Charles LA 70601-8528 | |
| (337) 794-1141 | |
| Not Available |
| Full Name | Jody Davidson Llc |
|---|---|
| Speciality | Counselor |
| Location | 315 Alamo St, Lake Charles, Louisiana |
| Authorized Official Name and Position | Jody Davidson (OWNER) |
| Authorized Official Contact | 3377941141 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jody Davidson Llc 1513 22nd St Lake Charles LA 70601-8821 Ph: (337) 794-1141 | Jody Davidson Llc 315 Alamo St Lake Charles LA 70601-8528 Ph: (337) 794-1141 |
| NPI Number | 1033878392 |
|---|---|
| Provider Enumeration Date | 12/14/2021 |
| Last Update Date | 01/12/2022 |
| Certification Date | 01/12/2022 |
| Medicare PECOS PAC ID | 0840682407 |
|---|---|
| Medicare Enrollment ID | O20220112000847 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033878392 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jody M Davidson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548457369 PECOS PAC ID: 8628134996 Enrollment ID: I20090311000721 |
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