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General NPI Number Information
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NPI Number | 1326354424
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Entity Type | Individual
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Provider Name | COURTNEY MAXWELL CAVALL LHMC
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Gender | Female
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Dates
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Enumeration Date | 08/26/2010
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Last Update Date | 03/10/2016
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Provider Practice Location Address
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Address Line | 4803 SEABERG RD
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City | ZEPHYRHILLS
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State | FL
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Zip | 33541-2862
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Country | US
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Telephone | 954-649-6592
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Fax |
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Provider Business Mailing Address
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Address Line | 4803 seaberg rd
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City | Zephyrhills
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State | Florida
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Zip | 33541
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Country | US
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Telephone | 9546496592
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health : Behavioral Health & Social Service Providers
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License Number | MH 10216
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License Number State | FL
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Taxonomy #2
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Taxonomy Code |
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Taxonomy Name | 101YM0800X
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License Number |
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License Number State |
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