Provider Demographics
NPI:1114164357
Name:DAVIS, YESHIVA D (LMFT)
Entity type:Individual
Prefix:
First Name:YESHIVA
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 GLENCOE AVE
Mailing Address - Street 2:#10082
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6444
Mailing Address - Country:US
Mailing Address - Phone:310-929-5519
Mailing Address - Fax:
Practice Address - Street 1:1105 N. LONG ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-1437
Practice Address - Country:US
Practice Address - Phone:310-929-5519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103TB0200X, 1041C0700X, 106H00000X
CAMFC52250106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical