Provider Demographics
NPI:1679271712
Name:DAVIS, ANNA (LCPC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N HIGGINS AVE STE 204W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4401
Mailing Address - Country:US
Mailing Address - Phone:406-282-1414
Mailing Address - Fax:
Practice Address - Street 1:111 N HIGGINS AVE STE 204W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4401
Practice Address - Country:US
Practice Address - Phone:406-282-1414
Practice Address - Fax:406-201-3307
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-70267101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health