Healthcare Provider Details

I. General information

NPI: 1255941209
Provider Name (Legal Business Name): COURTNEY CAVALL LMHC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4803 SEABERG RD
ZEPHYRHILLS FL
33541-2862
US

IV. Provider business mailing address

4803 SEABERG RD
ZEPHYRHILLS FL
33541-2862
US

V. Phone/Fax

Practice location:
  • Phone: 954-649-6592
  • Fax:
Mailing address:
  • Phone: 954-649-6592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY CAVALL
Title or Position: MBR
Credential: LMHC
Phone: 954-649-6592