MEDICARE: ANNA LAUREN KAVANAUGH LMFT, ATR-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	134592	CA

General Provider Information

NPI Number	:	1568963783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA LAUREN KAVANAUGH LMFT, ATR-BC

Provider Business Mailing Address
First Line	:	1401 N TUSTIN AVE STE 225
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-8688
Country	:	US
Telephone Number	:	714-221-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 PACIFIC COAST HWY STE 106
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-2734
Country	:	US
Telephone Number	:	424-247-6010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2018
Last Update Date	:	01/07/2026

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