Provider Demographics
NPI:1356552418
Name:DAVIS, JOSEPH MARCUS III (MFT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MARCUS
Last Name:DAVIS
Suffix:III
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 29TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2010
Mailing Address - Country:US
Mailing Address - Phone:310-450-3521
Mailing Address - Fax:
Practice Address - Street 1:9171 WILSHIRE BLVD STE 615
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5515
Practice Address - Country:US
Practice Address - Phone:310-777-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43337106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist