Provider Demographics
NPI:1134986144
Name:DAVIS, SHEA
Entity type:Individual
Prefix:
First Name:SHEA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SHEA
Other - Middle Name:
Other - Last Name:WHITNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1464 GRIDLEY RD
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-9620
Mailing Address - Country:US
Mailing Address - Phone:805-340-0079
Mailing Address - Fax:
Practice Address - Street 1:864 E SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2939
Practice Address - Country:US
Practice Address - Phone:805-643-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program