Provider Demographics
NPI:1326874033
Name:DAVIS, JULIE ANN (PSYCHOLOGIST PSYD)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PSYCHOLOGIST PSYD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA PSYD
Mailing Address - Street 1:30101 TOWN CENTER DRIVE, STE. #200
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677
Mailing Address - Country:US
Mailing Address - Phone:949-287-2871
Mailing Address - Fax:
Practice Address - Street 1:30101 TOWN CENTER DRIVE, STE. #200
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677
Practice Address - Country:US
Practice Address - Phone:949-287-2871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY-24689103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical