Provider Demographics
NPI:1740624089
Name:DAVIS, LLOYD WAYNE (MS)
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:WAYNE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 572
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91031-0572
Mailing Address - Country:US
Mailing Address - Phone:626-485-7100
Mailing Address - Fax:626-308-9784
Practice Address - Street 1:790 E COLORADO BLVD STE 905A
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2113
Practice Address - Country:US
Practice Address - Phone:626-485-7100
Practice Address - Fax:626-657-2716
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health