Active NPI
Ida Davis
- Professional Counselor
- North Las Vegas, NV
National Provider Identifier
1114320165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- MI0553
- Practice address
- 570 West Cheyenne Avenue
North Las Vegas, NV 89030 - Phone
- (702) 205-2513
- NPI assigned
- Oct 6, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | MI0553 | NV | Primary |
Addresses
Primary practice location
570 West Cheyenne Avenue
North Las Vegas, NV 89030
Mailing address
2626 Blue Reef Drive
North Las Vegas, NV 89023
Phone (702) 205-2513
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MI0553 | NV | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412553600000",
"number": "1114320165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2626 BLUE REEF DRIVE",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "89023",
"telephone_number": "702-205-2513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "570 WEST CHEYENNE AVENUE",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "89030",
"telephone_number": "702-205-2513"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "IDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-10-06",
"last_updated": "2014-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NV",
"license": "MI0553",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.