Provider Demographics
NPI:1831806678
Name:DAVIS, BRETT ALLEN (LCSW)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:ALLEN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 HOWE AVE STE 390
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-8543
Mailing Address - Country:US
Mailing Address - Phone:916-566-7430
Mailing Address - Fax:916-566-7433
Practice Address - Street 1:1111 HOWE AVE STE 390
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-8543
Practice Address - Country:US
Practice Address - Phone:916-566-7430
Practice Address - Fax:916-566-7433
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88413101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health