Provider Demographics
NPI:1114164357
Name:DAVIS, YESHIVA D (LMFT)
Entity Type:Individual
Prefix:
First Name:YESHIVA
Middle Name:D
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 1:5200 W CENTURY BLVD STE 495
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5965
Mailing Address - Country:US
Mailing Address - Phone:617-320-9247
Mailing Address - Fax:
Practice Address - Street 1:5200 W CENTURY BLVD STE 495
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-5965
Practice Address - Country:US
Practice Address - Phone:617-320-9247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC52250106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist