MEDICARE: MS. STEPHANIE LYNN DAVIDSON AMFT #93103

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	93103	CA

General Provider Information

NPI Number	:	1255771010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE LYNN DAVIDSON AMFT #93103

Provider Business Mailing Address
First Line	:	201 W COLLINS AVE SPC 93
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-5612
Country	:	US
Telephone Number	:	310-408-2766
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 W SANTA ANA BLVD # 107-109
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-4558
Country	:	US
Telephone Number	:	714-667-7926
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	10/21/2019

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