Provider Demographics
NPI:1720176712
Name:DAVIS, HARRY JAMES (ADDICTION THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:JAMES
Last Name:DAVIS
Suffix:
Gender:M
Credentials:ADDICTION THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9635 ADOREE ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-4926
Mailing Address - Country:US
Mailing Address - Phone:562-803-4046
Mailing Address - Fax:
Practice Address - Street 1:733 HINDRY AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-3005
Practice Address - Country:US
Practice Address - Phone:310-348-9850
Practice Address - Fax:310-348-8446
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10OtherADDICTION THERAPIST