MEDICARE: MRS. GLORIA JEAN DAVIDSON MFT

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	101YM0800X	Mental Health Counselor	MFC33310	CA

General Provider Information

NPI Number	:	1558341545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GLORIA JEAN DAVIDSON MFT

Provider Business Mailing Address
First Line	:	2685 MARSH DR
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-2120
Country	:	US
Telephone Number	:	925-830-4553
Fax Number	:

Provider Business Practice Location Address
First Line	:	2682 BISHOP DR
Second Line	:	SUITE 211
City	:	SAN RAMON
State	:	CA
Zip	:	94583-4450
Country	:	US
Telephone Number	:	925-244-0873
Fax Number	:

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/08/2007

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