Healthcare Provider Details

I. General information

NPI: 1588655732
Provider Name (Legal Business Name): KATHRYN MAY DAVIS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NACC -- 162 FIRST STREET
PORT HUENEME CA
93043-0001
US

IV. Provider business mailing address

81 SAN BENITO AVE
VENTURA CA
93004-1148
US

V. Phone/Fax

Practice location:
  • Phone: 805-982-6325
  • Fax:
Mailing address:
  • Phone: 805-647-3096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY4616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: