Carl D Davis Jr.

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

2002030477 Issued in MO

Practice address

307 N Main St
Windsor, MO 65360-1449

Phone

(660) 647-9921

Fax

(660) 647-3617

NPI assigned

Jul 14, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Midwest Behavioral Health, LLC

  • Case Management Agency
  • Troy, MO
  • NPI 1700820099
  NPD (past) Authorized official
• Preferred Family Healthcare, Inc.

  dba Clarity Healthcare

  • Federally Qualified Health Center (FQHC)
  • Hannibal, MO
  • NPI 1306721709
  NPD (past)

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366468126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 STATION AVE",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653016778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 N MAIN ST",
            "city": "WINDSOR",
            "state": "MO",
            "postal_code": "653601449",
            "telephone_number": "660-647-9921",
            "fax_number": "660-647-3617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "CARL",
        "middle_name": "D",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MO",
            "license": "2002030477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brown & Associates of Windsor, LLC
• Cassie Elizabeth Brown, LCSW, MSW
• Lisa D Brown, PSYD
• Brandon Beck Carroll, PLP
• Amie Lynn Cooper
• Jennifer G. Dier, PLPC
• Amie Lynn Etters, MD
• Patrick James Fletcher, PSYD
• Fresh Start Adult Day Care of Missouri Inc
• Hannah Archos Gertonson, PLP, PSYD

• Cognitive & Behavioral Psychologist in Windsor, MO
• Providers in Windsor, MO by specialty
• Cognitive & Behavioral Psychologist in Missouri

• 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.