MEDICARE: ALYSSA A DAVIS MA, LMFT

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	390200000X	Student in an Organized Health Care Education/Training Program
2	106H00000X	Marriage & Family Therapist	LMFT130175	CA
3	106H00000X	Marriage & Family Therapist	130175	CA

General Provider Information

NPI Number	:	1598238230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA A DAVIS MA, LMFT

Provider Business Mailing Address
First Line	:	921 W AVENUE J STE C
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-3443
Country	:	US
Telephone Number	:	661-949-0131
Fax Number	:	661-729-8912

Provider Business Practice Location Address
First Line	:	16055 VENTURA BLVD STE 605
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436-2609
Country	:	US
Telephone Number	:	661-235-5495
Fax Number	:

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

Provider Enumeration Date	:	01/04/2019
Last Update Date	:	03/11/2026

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