Provider Demographics
NPI:1891881652
Name:DAVIS, JUDITH ANN (MFT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16195 SISKIYOU RD
Mailing Address - Street 2:SUITE 120-A
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1346
Mailing Address - Country:US
Mailing Address - Phone:760-946-2070
Mailing Address - Fax:760-946-1511
Practice Address - Street 1:16195 SISKIYOU RD
Practice Address - Street 2:SUITE 120-A
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1346
Practice Address - Country:US
Practice Address - Phone:760-946-2070
Practice Address - Fax:760-946-1511
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health