Provider Demographics
NPI:1578500559
Name:CAVENAH, DENNIS COLBERT (MS)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:COLBERT
Last Name:CAVENAH
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5272 S LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6564
Mailing Address - Country:US
Mailing Address - Phone:918-524-3300
Mailing Address - Fax:918-524-3302
Practice Address - Street 1:5272 S LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6544
Practice Address - Country:US
Practice Address - Phone:918-524-3300
Practice Address - Fax:918-524-3302
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3297101YM0800X
OK196106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist