Provider Demographics
NPI:1639201213
Name:FLEMING, DAVIS TIMOTHY (MFT)
Entity Type:Individual
Prefix:MR
First Name:DAVIS
Middle Name:TIMOTHY
Last Name:FLEMING
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2048 HIGH TOWER DR
Mailing Address - Street 2:#1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-3159
Mailing Address - Country:US
Mailing Address - Phone:323-960-5275
Mailing Address - Fax:
Practice Address - Street 1:2048 HIGH TOWER DR
Practice Address - Street 2:#1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-3159
Practice Address - Country:US
Practice Address - Phone:323-960-5275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist