Provider Demographics
NPI:1548626807
Name:DAVIS PSYCHOLOGICAL EDUCATIONAL SERVICES, INC.
Entity type:Organization
Organization Name:DAVIS PSYCHOLOGICAL EDUCATIONAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGICAL ASSISTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALPHONSO
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD,, MA, PPS
Authorized Official - Phone:323-422-7138
Mailing Address - Street 1:PO BOX 2619
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-0619
Mailing Address - Country:US
Mailing Address - Phone:323-422-7138
Mailing Address - Fax:323-777-6674
Practice Address - Street 1:10900 183RD ST
Practice Address - Street 2:SUITE 105
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5342
Practice Address - Country:US
Practice Address - Phone:323-854-6284
Practice Address - Fax:562-219-5013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-01
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94021086103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty