Provider Demographics
NPI:1538157318
Name:E. CLIFTON DAVIS, ED.D., & ASSOCIATES, P.C.
Entity type:Organization
Organization Name:E. CLIFTON DAVIS, ED.D., & ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:CLIFTON
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:214-438-3668
Mailing Address - Street 1:17304 PRESTON RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5618
Mailing Address - Country:US
Mailing Address - Phone:214-438-3668
Mailing Address - Fax:972-733-6812
Practice Address - Street 1:17304 PRESTON RD
Practice Address - Street 2:SUITE 800
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5618
Practice Address - Country:US
Practice Address - Phone:214-438-3668
Practice Address - Fax:972-733-6812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-2012103T00000X, 106H00000X, 103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2-2012OtherTEXAS PSYCHOLOGY LICENSE
TXOOY786Medicare PIN