Stellanda M Davis, LMSW, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

M4543 Issued in MS

Practice address

17280 Highway 17 South
Lexington, MS 39095-0479

Phone

(662) 834-1857

Fax

(662) 834-4937

NPI assigned

May 21, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1336358951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8596 BROZVILLE RD",
            "city": "LEXINGTON",
            "state": "MS",
            "postal_code": "390956856",
            "telephone_number": "662-834-4061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17280 HIGHWAY 17 SOUTH",
            "city": "LEXINGTON",
            "state": "MS",
            "postal_code": "390950479",
            "telephone_number": "662-834-1857",
            "fax_number": "662-834-4937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "STELLANDA",
        "middle_name": "M",
        "credential": "LMSW, MFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MS",
            "license": "M4543",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASTER LICENSE SOCIAL WOR",
            "identifier": "T0261",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE SOCIAL WORKER",
            "identifier": "M4543",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Lexington, MS
• Providers in Lexington, MS by specialty
• Marriage & Family Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.