Healthcare Provider Details

I. General information

NPI: 1689588246
Provider Name (Legal Business Name): JACOB DONOVAN CAVANAH ASSOCIATE MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 W BROADWAY STE 270
EUGENE OR
97401-3097
US

IV. Provider business mailing address

233 E MAIN ST STE 401
BOZEMAN MT
59715-5045
US

V. Phone/Fax

Practice location:
  • Phone: 986-206-0414
  • Fax:
Mailing address:
  • Phone: 986-206-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR9298
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: