MEDICARE: KRISTA E. CAVENY LPC

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	3310	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2231576	OTHER		CIGNA BEHAVIORAL HEALTH

General Provider Information

NPI Number	:	1730148222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA E. CAVENY LPC

Provider Business Mailing Address
First Line	:	6846 S CANTON AVE
Second Line	:	#501
City	:	TULSA
State	:	OK
Zip	:	74136-3412
Country	:	US
Telephone Number	:	918-745-0095
Fax Number	:	918-745-0190

Provider Business Practice Location Address
First Line	:	6846 S CANTON AVE
Second Line	:	#501
City	:	TULSA
State	:	OK
Zip	:	74136-3412
Country	:	US
Telephone Number	:	918-745-0095
Fax Number	:	918-745-0190

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	05/10/2011

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