Provider Demographics
NPI:1023547981
Name:BRYCE MCDAVITT PHD
Entity Type:Organization
Organization Name:BRYCE MCDAVITT PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-317-5235
Mailing Address - Street 1:11935 KLING ST APT 9
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-5406
Mailing Address - Country:US
Mailing Address - Phone:323-317-5235
Mailing Address - Fax:
Practice Address - Street 1:4370 TUJUNGA AVE STE 150
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2753
Practice Address - Country:US
Practice Address - Phone:323-801-8123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28942261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)