MEDICARE: TRISHA ANNETTE CAVINS L.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	15897	TX

General Provider Information

NPI Number	:	1316470891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISHA ANNETTE CAVINS L.P.C.

Provider Business Mailing Address
First Line	:	5822 SMOKE GLASS TRL
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-2351
Country	:	US
Telephone Number	:	214-697-5618
Fax Number	:	972-934-0301

Provider Business Practice Location Address
First Line	:	6350 LBJ FWY STE 252
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6402
Country	:	US
Telephone Number	:	214-697-5618
Fax Number	:	972-934-0301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2017
Last Update Date	:	04/11/2017

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