Provider Demographics
NPI:1174043681
Name:DAVENPORT, GREGORY (LMFT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:DAVENPORT
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 S KENSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-5147
Mailing Address - Country:US
Mailing Address - Phone:714-833-0433
Mailing Address - Fax:
Practice Address - Street 1:1940 W ORANGEWOOD AVE STE 110
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-5042
Practice Address - Country:US
Practice Address - Phone:714-833-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115460106H00000X
CA83564106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist