Provider Demographics
NPI:1013660265
Name:DAVIDSON, BRANDY LETOY (LMFT)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:LETOY
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9513 DELANEY CREEK BLVD APT 114
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-5180
Mailing Address - Country:US
Mailing Address - Phone:813-466-4275
Mailing Address - Fax:
Practice Address - Street 1:9513 DELANEY CREEK BLVD APT 114
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-5180
Practice Address - Country:US
Practice Address - Phone:813-466-4275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3479106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist