| Shaun Davis, Psyd, Llc | |
|
1308 E 1st St Newberg OR 97132-2941 | |
| (503) 495-3870 | |
| (971) 264-5330 |
| Full Name | Shaun Davis, Psyd, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1308 E 1st St, Newberg, Oregon |
| Authorized Official Name and Position | Shaun Davis (SOLE MEMBER) |
| Authorized Official Contact | 5034953870 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shaun Davis, Psyd, Llc Po Box 327 Yamhill OR 97148-0327 Ph: (503) 781-0674 | Shaun Davis, Psyd, Llc 1308 E 1st St Newberg OR 97132-2941 Ph: (503) 495-3870 |
| NPI Number | 1770107187 |
|---|---|
| Provider Enumeration Date | 06/01/2020 |
| Last Update Date | 06/01/2020 |
| Certification Date | 06/01/2020 |
| Medicare PECOS PAC ID | 5890117246 |
|---|---|
| Medicare Enrollment ID | O20200612001383 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770107187 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Shaun L Davis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699240184 PECOS PAC ID: 9133464910 Enrollment ID: I20181226000626 |
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