Jerry Davenport, LAC

NPI #1043579725 in Girard, Kansas

Provider Information

NPI Number: 1043579725
Entity Type: Individual
Name: Jerry Davenport, LAC
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor - Addiction (Substance Use Disorder)
Credential: LAC
Enumeration Date: May 15, 2012
Last Updated: May 15, 2012

Practice Location

Address: 810 CEDAR ST
City: Girard
State: Kansas
ZIP Code: 66743-2056
Phone: (620) 724-8806

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder)	101YA0400X	Primary

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Organizations

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Tiyospaye, Inc.	Counselor - Addiction (Substance Use Disorder)	Wichita	AI Deep Dive
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