Provider Demographics
NPI:1588655732
Name:DAVIS, KATHRYN MAY (PHD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MAY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 SAN BENITO AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-1148
Mailing Address - Country:US
Mailing Address - Phone:805-647-3096
Mailing Address - Fax:
Practice Address - Street 1:NACC -- 162 FIRST STREET
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93043-0001
Practice Address - Country:US
Practice Address - Phone:805-982-6325
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4616103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical