Healthcare Provider Details

I. General information

NPI: 1376130021
Provider Name (Legal Business Name): KEILEISHA LOUISE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31066 IRON CIR
TEMECULA CA
92591-4995
US

IV. Provider business mailing address

31066 IRON CIR
TEMECULA CA
92591-4995
US

V. Phone/Fax

Practice location:
  • Phone: 760-997-9067
  • Fax:
Mailing address:
  • Phone: 760-997-9067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: