MEDICARE: LORAINE OWEELA JOHNSON DAVIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	152993	CA

General Provider Information

NPI Number	:	1245535285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORAINE OWEELA JOHNSON DAVIS

Provider Business Mailing Address
First Line	:	1842 W 75TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-2322
Country	:	US
Telephone Number	:	323-394-0618
Fax Number	:

Provider Business Practice Location Address
First Line	:	1842 W 75TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-2322
Country	:	US
Telephone Number	:	323-394-0618
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2011
Last Update Date	:	05/07/2025

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