Healthcare Provider Details

I. General information

NPI: 1396653481
Provider Name (Legal Business Name): TAMARA DAVIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 183
VALLEY SPRINGS CA
95252-0183
US

IV. Provider business mailing address

PO BOX 183
VALLEY SPRINGS CA
95252-0183
US

V. Phone/Fax

Practice location:
  • Phone: 209-559-5715
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number141427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: