Healthcare Provider Details

I. General information

NPI: 1568963783
Provider Name (Legal Business Name): ANNA LAUREN KAVANAUGH LMFT, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANYA KAVANAUGH LMFT, ATR-BC

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 PACIFIC COAST HWY STE 106
HERMOSA BEACH CA
90254-2734
US

IV. Provider business mailing address

PO BOX 19
PORTOLA CA
96122-0019
US

V. Phone/Fax

Practice location:
  • Phone: 424-247-6010
  • Fax:
Mailing address:
  • Phone: 530-316-4248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number22-241
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT134592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: