Provider Demographics
NPI:1164209813
Name:DAVIS, JENNIFER VICTORIA (MA, AMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:VICTORIA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 BEVERLY BLVD UNIT 480924
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6529
Mailing Address - Country:US
Mailing Address - Phone:818-732-1395
Mailing Address - Fax:
Practice Address - Street 1:3808 W RIVERSIDE DR STE 400
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-5301
Practice Address - Country:US
Practice Address - Phone:818-732-1395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist