Healthcare Provider Details

I. General information

NPI: 1164547154
Provider Name (Legal Business Name): DAVIS COUNSELING MEDIATION & ADVOCACY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 LYNDELL TERR SUITE 130
DAVIS CA
95616-6205
US

IV. Provider business mailing address

2050 LYNDELL TERR SUITE 130
DAVIS CA
95616-6205
US

V. Phone/Fax

Practice location:
  • Phone: 530-759-1929
  • Fax: 530-759-1929
Mailing address:
  • Phone: 530-759-1929
  • Fax: 530-759-1929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY9009
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC42035
License Number StateCA

VIII. Authorized Official

Name: KATHRYN A SPECTOR
Title or Position: MARRIAGE AND FAMILY THERAPIST OFFIC
Credential: LMFT
Phone: 530-759-1929