Provider Demographics
NPI:1861717902
Name:DAVIS, BREE ELIZABETH (PSYD)
Entity type:Individual
Prefix:DR
First Name:BREE
Middle Name:ELIZABETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 W MANCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1656
Mailing Address - Country:US
Mailing Address - Phone:310-412-0879
Mailing Address - Fax:310-412-3365
Practice Address - Street 1:614 W MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1656
Practice Address - Country:US
Practice Address - Phone:310-412-0879
Practice Address - Fax:310-412-3365
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAXXXXX103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical