Tara L Davis, CNP, LPCC-S

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN.CNP.023645 Issued in OH

Practice address

1201 S Main St Ste 100
Canton, OH 44720-4283

Phone

(330) 244-8782

Fax

(330) 244-8795

NPI assigned

Mar 29, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

State licenses

Practice roles

Locations

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

• Avo Behavioral Health LLC

  • Multi-Specialty Clinic/Center
  • Canton, OH
  • NPI 1619590882
  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  OH, Professional

  Medicare reassignment NPD
• Avo Behavioral Health LLC

  • Adult Mental Health Clinic/Center
  • Canton, OH
  • NPI 1104431410
  NPD
• Vista Psychological & Counseling Centre LLC

  • Clinical Psychologist
  • Canton, OH
  • NPI 1558535658

  Psychiatric/Mental Health

  NPD

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1821118530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 S MAIN ST STE 100",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447204283",
            "telephone_number": "330-244-8782",
            "fax_number": "330-244-8795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 S MAIN ST STE 100",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447204283",
            "telephone_number": "330-244-8782",
            "fax_number": "330-244-8795"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "29099 Health Campus Dr Ste 280",
            "address_purpose": "LOCATION",
            "city": "Westlake",
            "state": "OH",
            "postal_code": "441455280",
            "country_code": "US",
            "telephone_number": "216-293-0282",
            "fax_number": "440-455-9757",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3745 Whipple Ave NW Ste A",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "OH",
            "postal_code": "447184805",
            "country_code": "US",
            "telephone_number": "330-331-7506",
            "fax_number": "234-285-6767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "TARA",
        "middle_name": "L",
        "credential": "CNP, LPCC-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.0008189-SUPV",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRN.CNP.023645",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0315885",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHIATRY",
            "identifier": "11797385",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Molly Rose Kathleen Davis, RN
• Patricia Anne Davis
• Samantha Lauren Davis
• Siobhan N. Davis, PC-CR, CDCA
• Steven E. Davis, MD
• Dierdre J Davison
• Jazmone Davison
• Kerrie Dawkins, PHARMD
• Dana L Dawson
• Hannah Rose Dawson

• Psychiatric/Mental Health Nurse Practitioner in Canton, OH
• Providers in Canton, OH by specialty
• Psychiatric/Mental Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.