Provider Demographics
NPI:1346888583
Name:DAVIS, BRANDEE NICOLE (MFT INTERN)
Entity Type:Individual
Prefix:MRS
First Name:BRANDEE
Middle Name:NICOLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7147 BLACK SAGE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-6042
Mailing Address - Country:US
Mailing Address - Phone:510-285-7054
Mailing Address - Fax:
Practice Address - Street 1:4915 ALTA DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3921
Practice Address - Country:US
Practice Address - Phone:702-704-4244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI1225106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist