Provider Demographics
NPI:1891944559
Name:DAVIS, KATHY MARIE (LMFT)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1622
Mailing Address - Country:US
Mailing Address - Phone:510-507-1591
Mailing Address - Fax:510-649-1258
Practice Address - Street 1:110 LAFAYETTE CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4315
Practice Address - Country:US
Practice Address - Phone:510-507-1591
Practice Address - Fax:510-649-1258
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45278106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist