MR. MICHAEL PATRICK DAVENPORT, PHD - NPI NUMBER 1659308104

Summary

Provider Name: MR. MICHAEL PATRICK DAVENPORT, PHD

NPI Number: 1659308104

Clasification: Psychologist (103T00000X)

Organization: M PATRICK DAVENPORT APPC

Address:
1002 HIGHLAND AVE
STE 300
SHREVEPORT, LA
ZIP 71101

Phone Number: (318) 222-6226



Detailed Information

MR. Michael Patrick Davenport, PHD is a psychologist in Shreveport, LA with 31 years of experience. The provider is a psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. The assigned NPI number for this provider is 1659308104 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business address is:

1002 HIGHLAND AVE
STE 300
SHREVEPORT, LA
ZIP 71101-143
Phone: (318) 222-6226
Fax: (318) 221-8526

The enumeration date for this NPI number is 6/27/2006 and was last updated on 7/8/2007.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 103T00000X Psychologist 464 LA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 56083 MEDICARE ID-TYPE UNSPECIFIED LA MEDICARE PROV ID
2 721409091001 OTHER LA HUMANA MILITARY

NPI Record

No. Field Name Field Value
1 NPI 1659308104
2 Entity Type Code 1
3 Provider Last Name Legal Name DAVENPORT
4 Provider First Name MICHAEL
5 Provider Middle Name PATRICK
6 Provider Name Prefix Text MR.
7 Provider Credential Text PHD
8 Provider First Line Business Practice Location Address 1002 HIGHLAND AVE
9 Provider Second Line Business Practice Location Address STE 300
10 Provider Business Practice Location Address City Name SHREVEPORT
11 Provider Business Practice Location Address State Name LA
12 Provider Business Practice Location Address Postal Code 711014143
13 Provider Business Practice Location Address Country Code If outside U S US
14 Provider Business Practice Location Address Telephone Number 3182226226
15 Provider Business Practice Location Address Fax Number 3182218526
16 Provider Enumeration Date 6/27/2006
17 Last Update Date 7/8/2007
18 Provider Gender Code M
19 Healthcare Provider Taxonomy Code 1 103T00000X
20 Provider License Number 1 464
21 Provider License Number State Code 1 LA
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Other Provider Identifier 1 56083
24 Other Provider Identifier Type Code 1 04
25 Other Provider Identifier State 1 LA
26 Other Provider Identifier Issuer 1 MEDICARE PROV ID
27 Other Provider Identifier 2 721409091001
28 Other Provider Identifier Type Code 2 01
29 Other Provider Identifier State 2 LA
30 Other Provider Identifier Issuer 2 HUMANA MILITARY
31 Is Sole Proprietor N

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This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.