Provider Demographics
NPI:1578928313
Name:DAVIS, SUSAN MELANIE
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MELANIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 BIG TALK CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-3910
Mailing Address - Country:US
Mailing Address - Phone:805-317-3349
Mailing Address - Fax:
Practice Address - Street 1:1254 BIG TALK CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-3910
Practice Address - Country:US
Practice Address - Phone:805-317-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health