Healthcare Provider Details

I. General information

NPI: 1720333008
Provider Name (Legal Business Name): KRISTINE J CAVANESS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2367 S ROOSEVELT DR
SEASIDE OR
97138-6550
US

IV. Provider business mailing address

1027 E BURNSIDE ST
PORTLAND OR
97214-1328
US

V. Phone/Fax

Practice location:
  • Phone: 971-369-5461
  • Fax: 503-738-2116
Mailing address:
  • Phone: 503-239-8400
  • Fax: 503-239-8406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: