Doctor Name: | TRACEY KAVANAGH |
NPI Number: | 1184641052 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | MH4678 |
Business Practice Address: | 3215 Hendricks Ave Suite 3 Jacksonville, FL - 322074280 |
Business Phone Number: | 9043182258 |
Business Fax Number: | 9048081472 |
Mailing Address: | 568 Saint Claude Pl, SAINT JOHNS |
State: | FL |
Postal Code: | 322594074 |
Phone Number: | 9043182258 |
Fax Number: | 9048081472 |
NPI Enumeration Date: | 07/16/2006 |
NPI Last Update Date: | 01/29/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | MH4678 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |