Jessica Davidson, MA, LPC, ATR
Individual provider Active NPI Professional Counselor · Town and Country, MO
NPI 1053766980 · NPPES record last updated Nov 19, 2016
Key facts
- NPI
- 1053766980
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 2008027607 (MO)
- Practice address
- 14426 S Outer 40 Rd
Town and Country, MO 63017-5711 - Phone
- (636) 224-1300
- NPI assigned
- Apr 28, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180008597 | IL | MD | Professional Counselor |
| 2008027607 | MO | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2008027607 | MO | Yes |
| Professional Counselor | 101YP2500X | 180008597 | IL |
Addresses
Primary practice location
14426 S Outer 40 Rd
Town and Country, MO 63017-5711
Mailing address
14426 S Outer 40 Rd
Town and Country, MO 63017-5711
Phone (636) 224-1300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13545669 | Other | CAQH |
Other providers in Town and Country, MO
- Clayton Road Healthcare LLC
- Lora Pearlman Collier
- Cotton Babies, Inc.
- Deb Crawford
- Curators of the University of Missouri
- Sara Denney
- Paul Eaton
- Emily Hahn DDS LLC
- Finding Freedom Nutrition and Counseling, LLC
- Pamela Joan Fisher
All providers in Town and Country, MO · Professional Counselor in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.