Provider Demographics
NPI:1568963783
Name:KAVANAUGH, ANNA (LMFT, ATR)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KAVANAUGH
Suffix:
Gender:M
Credentials:LMFT, ATR
Other - Prefix:
Other - First Name:ANYA
Other - Middle Name:
Other - Last Name:KAVANAUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2401 PACIFIC COAST HWY STE 106
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2734
Mailing Address - Country:US
Mailing Address - Phone:424-247-6010
Mailing Address - Fax:
Practice Address - Street 1:2401 PACIFIC COAST HWY STE 106
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2734
Practice Address - Country:US
Practice Address - Phone:424-247-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134592106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist