Provider Demographics
NPI:1497852354
Name:DAVIS, DENISE EVELYN (MFT)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:EVELYN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:E
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:17772 IRVINE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3234
Mailing Address - Country:US
Mailing Address - Phone:714-544-9655
Mailing Address - Fax:
Practice Address - Street 1:17772 IRVINE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-544-9655
Practice Address - Fax:714-549-3381
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT20490106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist