Healthcare Provider Details

I. General information

NPI: 1063539369
Provider Name (Legal Business Name): JESSICA BROOKE DAVIS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 N KENWOOD ST
BURBANK CA
91505
US

IV. Provider business mailing address

1103 N KENWOOD ST
BURBANK CA
91505
US

V. Phone/Fax

Practice location:
  • Phone: 626-827-6786
  • Fax:
Mailing address:
  • Phone: 626-827-6786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number121499
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT0003080
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: