Healthcare Provider Details

I. General information

NPI: 1306181292
Provider Name (Legal Business Name): JULIA ALICE DAVIS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIA MOBASSALEH LMFT

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64155 VAN DYKE RD # 213
WASHINGTON MI
48095-2580
US

IV. Provider business mailing address

64155 VAN DYKE RD # 213
WASHINGTON MI
48095-2580
US

V. Phone/Fax

Practice location:
  • Phone: 949-357-0255
  • Fax:
Mailing address:
  • Phone: 949-357-0255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF61297592
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number91207
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT5076
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101006762
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: