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General NPI Number Information
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NPI Number | 1023290178
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Entity Type | Organization
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Legal Business Name | RENEE COLLEEN DAVIS
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 19558 EMANUEL DR SUITE B
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City | RIVERSIDE
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State | CA
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Zip | 92508-6815
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Country | US
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Telephone | 951-235-2241
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Fax |
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Provider Business Mailing Address
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Address Line | 19558 EMANUEL DR
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City | RIVERSIDE
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State | CA
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Zip | 92508-6815
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Country | US
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Telephone | 951-235-2241
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Fax |
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Authorized Official
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Title or Position | MARRIAGE & FAMILY THERAPIST
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Name | MS. RENEE COLLEEN DAVIS
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Credential | LMFT
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Telephone | 951-235-2241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | MFC45046
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License Number State | CA
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