Provider Demographics
NPI:1861865727
Name:DAVIS, EVAN JAMES
Entity Type:Individual
Prefix:MRS
First Name:EVAN
Middle Name:JAMES
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVAN
Other - Middle Name:MARIE
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3371 GLENDALE BLVD # 463
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1846
Mailing Address - Country:US
Mailing Address - Phone:469-878-5851
Mailing Address - Fax:
Practice Address - Street 1:3191 CASITAS AVE STE 157
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2470
Practice Address - Country:US
Practice Address - Phone:323-487-0724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-01
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT107944106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist