Basic Information
| Provider Information | |||||||||
| NPI: | 1861935223 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | STROM | ||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 867 | ||||||||
| Address2: | |||||||||
| City: | PRICE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 845010867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356377200 | ||||||||
| FaxNumber: | 4356372377 | ||||||||
| Practice Location | |||||||||
| Address1: | 13460 WALSH DR | ||||||||
| Address2: | |||||||||
| City: | BOYS TOWN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680107529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5313553362 | ||||||||
| FaxNumber: | 5313553375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2016 | ||||||||
| LastUpdateDate: | 05/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101Y00000X | 12554 | NE | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.