Provider Demographics
NPI:1346928850
Name:DAVIDSON, SPENCER M (LMFTA)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:M
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W MISSION AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2355
Mailing Address - Country:US
Mailing Address - Phone:509-670-0519
Mailing Address - Fax:
Practice Address - Street 1:222 W MISSION AVE STE 105
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2355
Practice Address - Country:US
Practice Address - Phone:509-670-0519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61434194106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist