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General NPI Number Information
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NPI Number | 1831634526
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Entity Type | Organization
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Legal Business Name | DANIEL DAVIS LICENSED MARRIAGE AND FAMILY THERAPIST A PROFESSIONAL COR
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Dates
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Enumeration Date | 01/04/2017
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Last Update Date | 01/04/2017
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Provider Practice Location Address
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Address Line | 1588 HOMESTEAD ROAD SUITE G
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City | SANTA CLARA
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State | CA
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Zip | 95050-4783
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Country | US
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Telephone | 408-249-0014
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Fax | 408-249-0018
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Provider Business Mailing Address
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Address Line | 1588 HOMESTEAD RD MAILBOX 1
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City | SANTA CLARA
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State | CA
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Zip | 95050-4783
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Country | US
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Telephone | 408-249-0014
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Fax | 408-249-0018
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DANIEL ROBERT DAVIS
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Credential | LMFT
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Telephone | 408-249-0014
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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 | MFT35938
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License Number State | CA
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