Davis, Jerry Eugene

Davis, Jerry Eugene is an individual health care provider with primary practice located at 2821 Hillegas Rd , Fort Wayne IN 46808-3859. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Mental Health is his primary health care specialty. Davis, Jerry Eugene can be contacted via phone (260) 471-1950.

Contact Information

Primary practice address
2821 Hillegas Rd Fort Wayne IN 46808-3859
Phone: (260) 471-1950
Fax: (260) 471-1950
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 39000593A Indiana
Behavioral Health & Social Service Providers / Clinical 1041C0700X 34002606A Indiana
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 35000571A Indiana

Profile Details

NPI number 1205935392
LBN Legal business name Davis, Jerry Eugene
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 22nd, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205935392 NPPES
Indiana Other 000000183652 ANTHEM BCBS
Indiana Other 7389148 ANTHEM BCBS

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