MEDICARE: JAY CAVENDER LPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	05123	AL

General Provider Information

NPI Number	:	1619733268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY CAVENDER LPC

Provider Business Mailing Address
First Line	:	48 MEDICAL PARK DR E STE 453
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35235-3472
Country	:	US
Telephone Number	:	205-208-9312
Fax Number	:	205-848-2227

Provider Business Practice Location Address
First Line	:	2010 S POINT PARK CIR STE 200
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-5478
Country	:	US
Telephone Number	:	256-880-5818
Fax Number	:

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

Provider Enumeration Date	:	02/22/2024
Last Update Date	:	06/08/2026

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