Provider Demographics
NPI:1043996689
Name:DAVIES, THOMAS (AMFT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:DAVIES
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:MR
Other - First Name:TAD
Other - Middle Name:
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:700 FREDERICK ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2239
Mailing Address - Country:US
Mailing Address - Phone:831-996-1222
Mailing Address - Fax:831-417-0443
Practice Address - Street 1:700 FREDERICK ST STE 103
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2239
Practice Address - Country:US
Practice Address - Phone:831-996-1222
Practice Address - Fax:831-417-0443
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140148106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist