Provider Demographics
NPI:1679611099
Name:DAVIS, NORMAN A (PSYD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 MARAZAN ST
Mailing Address - Street 2:
Mailing Address - City:DENAIR
Mailing Address - State:CA
Mailing Address - Zip Code:95316
Mailing Address - Country:US
Mailing Address - Phone:209-664-1300
Mailing Address - Fax:209-664-1311
Practice Address - Street 1:202 WEST MAIN ST
Practice Address - Street 2:#201
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380
Practice Address - Country:US
Practice Address - Phone:209-664-1300
Practice Address - Fax:209-664-1311
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17314103T00000X
KY695103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist