Provider Demographics
NPI:1184037996
Name:DAVENPORT, ZACHARY ALLEN (MS)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:ALLEN
Last Name:DAVENPORT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2191 MARKET ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1399
Mailing Address - Country:US
Mailing Address - Phone:415-575-1100
Mailing Address - Fax:415-575-1106
Practice Address - Street 1:2191 MARKET ST
Practice Address - Street 2:SUITE A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1399
Practice Address - Country:US
Practice Address - Phone:415-575-1100
Practice Address - Fax:415-575-1106
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81432106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist