MEDICARE: MR. JARED DAVID GAVIN LCSW

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	101YM0800X	Mental Health Counselor	3607	NE
2	1041C0700X	Clinical Social Worker	105496	TX
3	1041C0700X	Clinical Social Worker	1339	NE

General Provider Information

NPI Number	:	1356480487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JARED DAVID GAVIN LCSW

Provider Business Mailing Address
First Line	:	949 WHITEHALL DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75023-6736
Country	:	US
Telephone Number	:	214-814-4788
Fax Number	:

Provider Business Practice Location Address
First Line	:	6851 VIRGINIA PKWY STE 211
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-5637
Country	:	US
Telephone Number	:	214-997-3359
Fax Number	:

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	02/28/2025

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