Mikol S. Davis, ED.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY 9063 Issued in CA

Practice address

930 Irwin St
Suite 215
San Rafael, CA 94901-3340

Phone

(415) 459-1203

NPI assigned

Aug 12, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

University of California, San Francisco School of Medicine, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mikol S Davis Child & Family Counseling a Prof Corp

  • Clinical Psychologist
  • San Rafael, CA
  • NPI 1033412853
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359417600000",
    "number": "1073525895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 IRWIN ST",
            "address_2": "SUITE 215",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013340",
            "telephone_number": "415-459-1203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 IRWIN ST",
            "address_2": "SUITE 215",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013340",
            "telephone_number": "415-459-1203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "MIKOL",
        "middle_name": "S.",
        "credential": "ED.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2013-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 9063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittney Davis, CCAPP
• Christina Davis
• Cora Davis
• Enda Vene'E Davis
• Kelly Susan Davis
• Natalie Lyne Davis
• Tatem Julie Davis
• Chelsea Day
• Jason Smith Day, M.D.
• Adam Dayan

• Clinical Psychologist in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.