Provider Demographics
NPI:1326354424
Name:CAVALL, COURTNEY MAXWELL (LHMC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MAXWELL
Last Name:CAVALL
Suffix:
Gender:F
Credentials:LHMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10216101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024451900OtherMEDICAID 907 - SPECIALIZED THERAPEUTIC SERVICE.
FL024475500OtherMEDICAID-39-BEHAVIOR ANALYSIS.