Provider Demographics
NPI:1255941209
Name:COURTNEY CAVALL LMHC LLC
Entity type:Organization
Organization Name:COURTNEY CAVALL LMHC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-649-6592
Mailing Address - Street 1:4803 SEABERG RD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-2862
Mailing Address - Country:US
Mailing Address - Phone:954-649-6592
Mailing Address - Fax:
Practice Address - Street 1:4803 SEABERG RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-2862
Practice Address - Country:US
Practice Address - Phone:954-649-6592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024475500Medicaid
FL024451900Medicaid
FL590688286OtherLICENSED MENTAL HEALTH COUNSELOR, LMHC, MH 10216. FLORIDA DEPARTMENT OF HEALTH
FL108005400Medicaid