Basic Information
| Provider Information | |||||||||
| NPI: | 1376206235 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIDS | ||||||||
| FirstName: | CLINT | ||||||||
| MiddleName: | STEVEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1806 HILTON DR | ||||||||
| Address2: | |||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915041919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262345863 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2750 E WASHINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911071448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262968900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2021 | ||||||||
| LastUpdateDate: | 12/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 106H00000X | 130034 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.