MEDICARE: MS. TAYSHA CHENELL DAVISTON 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	101YM0800X	Mental Health Counselor	125496	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	106H00000X	Marriage & Family Therapist	125496	CA
4	106H00000X	Marriage & Family Therapist	LMFT163469	CA

General Provider Information

NPI Number	:	1942728688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAYSHA CHENELL DAVISTON LMFT

Provider Business Mailing Address
First Line	:	275 BECK AVE # MS 5-230
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-6804
Country	:	US
Telephone Number	:	707-784-8137
Fax Number	:	707-427-2759

Provider Business Practice Location Address
First Line	:	275 BECK AVE # MS 5230
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-6804
Country	:	US
Telephone Number	:	707-784-8137
Fax Number	:	707-427-2759

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

Provider Enumeration Date	:	09/01/2017
Last Update Date	:	06/11/2026

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