Provider Demographics
NPI:1114115888
Name:DAVIS, JENNIFER RENEE (LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 CROW CANYON RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1639
Mailing Address - Country:US
Mailing Address - Phone:925-298-7172
Mailing Address - Fax:925-208-1173
Practice Address - Street 1:2817 CROW CANYON RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1639
Practice Address - Country:US
Practice Address - Phone:925-298-7172
Practice Address - Fax:925-208-1173
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC49934101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health