Provider Demographics
NPI:1902536618
Name:DAVIS, HOLLIS LETRICE (MHP)
Entity Type:Individual
Prefix:
First Name:HOLLIS
Middle Name:LETRICE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 INDUSTRIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3207
Mailing Address - Country:US
Mailing Address - Phone:337-534-0254
Mailing Address - Fax:
Practice Address - Street 1:105 INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3207
Practice Address - Country:US
Practice Address - Phone:337-534-0254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty