Healthcare Provider Details

I. General information

NPI: 1356841241
Provider Name (Legal Business Name): MISTER CAVANAUGH SEARCY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23860 HAWTHORNE BLVD STE 200
TORRANCE CA
90505-8201
US

IV. Provider business mailing address

PO BOX 43424
LOS ANGELES CA
90043-0424
US

V. Phone/Fax

Practice location:
  • Phone: 310-791-3064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: