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General NPI Number Information
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NPI Number | 1386760387
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Entity Type | Individual
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Provider Name | KIM DAVIS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 12/26/2018
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Provider Practice Location Address
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Address Line | 16055 VENTURA BLVD STE 1033
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City | ENCINO
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State | CA
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Zip | 91436
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Country | US
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Telephone | 310-281-6645
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Fax |
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Provider Business Mailing Address
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Address Line | 11738 OTSEGO ST
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-3221
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Country | US
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Telephone | 310-709-6020
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | RPS 2006 098
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY21796
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License Number State | CA
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