Provider Demographics
NPI:1144883414
Name:DAVIS, TRENDOLYN DESHA (MA,LPC)
Entity type:Individual
Prefix:
First Name:TRENDOLYN
Middle Name:DESHA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:TRENDOLYN
Other - Middle Name:DESHA
Other - Last Name:RIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1216 DUNCAN RD
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-7409
Mailing Address - Country:US
Mailing Address - Phone:254-577-4880
Mailing Address - Fax:254-518-5300
Practice Address - Street 1:1216 DUNCAN RD
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-7409
Practice Address - Country:US
Practice Address - Phone:254-577-4880
Practice Address - Fax:254-518-5300
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76579101Y00000X, 101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor