Lori Lynn Davenport, LPC
Individual provider Active NPI Professional Counselor · Payson, AZ
NPI 1689171654 · NPPES record last updated Mar 13, 2021
Key facts
- NPI
- 1689171654
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- LPC-17175 (AZ)
- Practice address
- 901 E Park Dr
Payson, AZ 85541-4442 - Phone
- (928) 970-1027
- NPI assigned
- Apr 6, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2009
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
- Group practices
- Southwest Behavioral Health Services Inc
Practice addresses (Care Compare)
1845 McCulloch Blvd N
Suite B1
Lake Havasu City, AZ 86403-6774
Phone (928) 453-2661
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250617001020 | AZ | Practitioner - Mental Health Counselor | 8820509813 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-17175 | AZ | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwest Behavioral Health Services Inc | Current |
Accepting new patients | |
| Southwest Behavioral Health Services, Inc. | Current |
Accepting new patients |
Locations
1845 McCulloch Blvd N
Ste B1
Lake Havasu City, AZ 86403
Phone (928) 453-2661
404 W Aero Dr
Payson, AZ 85541
Phone (928) 238-3024
2042 N 35th Ave
Phoenix, AZ 85009
Phone (602) 233-0115
3450 N 3rd St
Phoenix, AZ 85012
Phone (602) 257-9339
7600 E Florentine Rd
Ste 101
Prescott Valley, AZ 86314
Phone (928) 775-7088
7600 E Florentine Rd
Ste 201
Prescott Valley, AZ 86314
Phone (928) 775-7088
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC-17175 | AZ | Yes |
Addresses
Primary practice location
901 E Park Dr
Payson, AZ 85541-4442
Mailing address
901 E Park Dr
Payson, AZ 85541-4442
Phone (928) 970-1027
Other providers in Payson, AZ
- Michael Crossman
- Cindy Lee Croy
- Cynthia D. Booth, MD PLLC
- Dan Nurse Practitioner Services, LLC
- Michael D Darnell
- Michael Keene Demack
- Derek R Sloan DDS PLLC
- Desert Dentistry, PLLC
- Dexter D Dewitt
- Diana L Easton
All providers in Payson, AZ · Professional Counselor in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.