Provider Demographics
NPI:1437290566
Name:DAVIS, GAIL M (LMFT)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 EL DORADO AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2834
Mailing Address - Country:US
Mailing Address - Phone:831-427-4510
Mailing Address - Fax:831-462-3576
Practice Address - Street 1:1550 EL DORADO AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2834
Practice Address - Country:US
Practice Address - Phone:831-427-4510
Practice Address - Fax:831-462-3576
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC12159106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist