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 32 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

Similar Providers

NPI Provider Name / Taxonomy
1033273107 JEANNE STREET, PHD
Psychologist (Clinical)
1043327968 DR. BRUCE K MCCORMICK, PHD
Psychologist
1104937952 DR. ROBERT HERBERT JORDAN, PH.D.
Psychologist
1376678045 DR. GARY E. MILFORD, PHD., M.S.C.P.
Psychologist
1114281078 DR. RICHARD LEWIS PRICE, PH.D.
Psychologist (Clinical)
1194832014 CHERYL S MARSIGLIA, PHD
Psychologist
1144231416 DR. LINDA J. HARTWELL, PH.D.,MSCP
Psychologist (Clinical)





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 Field Definition 1
1 NPI 1659308104 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 1 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Provider Last Name Legal Name DAVENPORT The last name of the provider. If the provider is an individual, this is the legal name.
4 Provider First Name MICHAEL The first name of the provider, if the provider is an individual.
5 Provider Middle Name PATRICK The middle name of the provider, if the provider is an individual.
6 Provider Name Prefix Text MR. The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
7 Provider Credential Text PHD The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
8 Provider First Line Business Practice Location Address 1002 HIGHLAND AVE The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Second Line Business Practice Location Address STE 300 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
10 Provider Business Practice Location Address City Name SHREVEPORT The city name in the location address of the provider being identified.
11 Provider Business Practice Location Address State Name LA The State code in the location of the provider being identified.
12 Provider Business Practice Location Address Postal Code 711014143 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
13 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
14 Provider Business Practice Location Address Telephone Number 3182226226 The telephone number associated with the location address of the provider being identified.
15 Provider Business Practice Location Address Fax Number 3182218526 The fax number associated with the location address of the provider being identified.
16 Provider Enumeration Date 6/27/2006 The date the provider was assigned a unique identifier (assigned an NPI).
17 Last Update Date 7/8/2007 The date that a record was last updated or changed.
18 Provider Gender Code M The code designating the provider’s gender if the provider is a person.
19 Healthcare Provider Taxonomy Code 1 103T00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
20 Provider License Number 1 464 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
21 Provider License Number State Code 1 LA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Other Provider Identifier 1 56083 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
24 Other Provider Identifier Type Code 1 04 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier State 1 LA
26 Other Provider Identifier Issuer 1 MEDICARE PROV ID
27 Other Provider Identifier 2 721409091001 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier Type Code 2 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
29 Other Provider Identifier State 2 LA
30 Other Provider Identifier Issuer 2 HUMANA MILITARY
31 Is Sole Proprietor N Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No

Download Record

Download this NPI record in Text format: Export

Download this NPI record in Excel (CSV) format: Export

Download this NPI record in XML format: Export




This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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.