Provider Demographics
NPI:1063585446
Name:CAVE, VAN EDEN (MC, LPC)
Entity type:Individual
Prefix:
First Name:VAN
Middle Name:EDEN
Last Name:CAVE
Suffix:
Gender:M
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20165 N 67TH AVE
Mailing Address - Street 2:SUITE 122A PMB 144
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7002
Mailing Address - Country:US
Mailing Address - Phone:602-485-1245
Mailing Address - Fax:623-878-0233
Practice Address - Street 1:7075 W BELL RD
Practice Address - Street 2:SUITE 3
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8546
Practice Address - Country:US
Practice Address - Phone:602-485-1245
Practice Address - Fax:623-878-0233
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-2363101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health