Provider Demographics
NPI:1609093087
Name:CAVAZOS-BEAL, JUDITH (LMFT, LADC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:CAVAZOS-BEAL
Suffix:
Gender:F
Credentials:LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8120 PENN AVE S STE 270
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1320
Mailing Address - Country:US
Mailing Address - Phone:800-336-5973
Mailing Address - Fax:612-234-4689
Practice Address - Street 1:8120 PENN AVE S STE 270
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1320
Practice Address - Country:US
Practice Address - Phone:800-336-5973
Practice Address - Fax:612-234-4689
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
302000101YA0400X
MN2206106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)