Provider Demographics
NPI:1275011900
Name:DAVIS, BLAIR J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1156 HIGH ST
Mailing Address - Street 2:COWELL STUDENT HEALTH CENTER, CAPS
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95064-1077
Mailing Address - Country:US
Mailing Address - Phone:831-459-5883
Mailing Address - Fax:831-459-5116
Practice Address - Street 1:1156 HIGH ST
Practice Address - Street 2:COWELL STUDENT HEALTH CENTER, CAPS
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95064-1077
Practice Address - Country:US
Practice Address - Phone:831-459-5883
Practice Address - Fax:831-459-5116
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24930103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical