Provider Demographics
NPI:1144029919
Name:DAVENPORT COUNSELING. LLC
Entity type:Organization
Organization Name:DAVENPORT COUNSELING. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:615-500-1959
Mailing Address - Street 1:417 WELSHWOOD DR STE 304C
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4248
Mailing Address - Country:US
Mailing Address - Phone:615-554-5075
Mailing Address - Fax:
Practice Address - Street 1:417 WELSHWOOD DR STE 304C
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4248
Practice Address - Country:US
Practice Address - Phone:615-554-5075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty