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General NPI Number Information
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NPI Number | 1215191507
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Entity Type | Individual
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Provider Name | KRISTIN SHERRIE DAVIS M.ED.
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Gender | Female
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 04/28/2014
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Provider Practice Location Address
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Address Line | 2500 WILSHIRE BLVD STE 700
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City | LOS ANGELES
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State | CA
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Zip | 90057-4312
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Country | US
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Telephone | 213-639-2660
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Fax |
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Provider Business Mailing Address
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Address Line | 758 W 18TH ST APT B
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City | COSTA MESA
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State | CA
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Zip | 92627-5213
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Country | US
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Telephone | 541-206-8372
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 125475
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 61593
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License Number State | CA
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