Tyla Davenport
NPI #1114575628 in Vicksburg, Mississippi
Provider Information
- NPI Number
- 1114575628
- Entity Type
- Individual
- Name
- Tyla Davenport
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Counselor - Mental Health
- Enumeration Date
- Aug 28, 2019
- Last Updated
- Aug 28, 2019
Practice Location
- Address
- 3444 WISCONSIN AVE
- City
- Vicksburg
- State
- Mississippi
- ZIP Code
- 39180-5331
- Phone
- (601) 638-0031
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Mental Health — Mental Health |
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