Organization Name: | REGINA CAVANAUGH, M.D. |
NPI Number: | 1053431429 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | REGINA KRISTINE CAVANAUGH (OWNER) |
Mailing Address: | 775 Indian Trl Harker Heights |
State: | TX US |
Postal Code: | 765487025 |
Phone Number: | 2546982216 |
Fax Number: | 2546982296 |
NPI Enumeration Date: | 03/30/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC2200X |
License Number: | J4031 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical Child & Adolescent |
Taxonomy Definition: |