Provider Demographics
NPI:1063892164
Name:DAVIS, STEPHEN GLEN II (PSYD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GLEN
Last Name:DAVIS
Suffix:II
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 BUTTE ST
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-3003
Mailing Address - Country:US
Mailing Address - Phone:530-905-0176
Mailing Address - Fax:
Practice Address - Street 1:222 BUTTE ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3003
Practice Address - Country:US
Practice Address - Phone:530-905-0176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25207103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical