Nicole Davis, PSYD

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

PSB94026437 Issued in CA

Practice address

128 Sierra St Ste C
El Segundo, CA 90245-4117

Phone

(310) 989-1971

NPI assigned

Aug 18, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Nicole Davis Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• DBT California

  • Clinical Psychologist
  • Los Angeles, CA
  • NPI 1689100521
  NPD (past)

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

{
    "created_epoch": "1597708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1972115293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 WATERVIEW ST",
            "city": "PLAYA DEL REY",
            "state": "CA",
            "postal_code": "902938052",
            "telephone_number": "213-840-1389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 SIERRA ST STE C",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902454117",
            "telephone_number": "310-989-1971"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11340 W Olympic Blvd Ste 268",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900641612",
            "country_code": "US",
            "telephone_number": "714-576-6819",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "NICOLE",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-18",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "PSB94026437",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ndavis@ebtherapypartners.com",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "11340 W Olympic Blvd Ste 268",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900641612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "DAVIS",
            "credential": "PSYD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Lyndsey Davis
• Makayla Davis
• Malaika Davis
• Michaela Davis
• Nia Davis
• Nijah Davis
• Raina Davis
• Shakeya Davis
• Shawna Davis
• Symonne Davis

• Mental Health Counselor in El Segundo, CA
• Providers in El Segundo, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.