Provider Demographics
NPI:1013521350
Name:LONGSHORE, DAVENA LIMITLESS (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVENA
Middle Name:LIMITLESS
Last Name:LONGSHORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DAVENA
Other - Middle Name:LIMITLESS
Other - Last Name:LONGSHORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1534 IRATCABAL DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-8637
Mailing Address - Country:US
Mailing Address - Phone:661-617-9071
Mailing Address - Fax:
Practice Address - Street 1:4781 CAUGHLIN PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-0906
Practice Address - Country:US
Practice Address - Phone:775-826-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program