Healthcare Provider Details

I. General information

NPI: 1306152822
Provider Name (Legal Business Name): MEGAN BETH DAVIS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 CHALLENGER WAY
SANTA ROSA CA
95407
US

IV. Provider business mailing address

16274 APRICOT LN
ROYAL OAKS CA
95076-8428
US

V. Phone/Fax

Practice location:
  • Phone: 707-205-9149
  • Fax: 707-569-2444
Mailing address:
  • Phone: 831-320-9213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY30750
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: