Provider Demographics
NPI:1619522489
Name:CAVILL, ANGELA LEE (PLMHP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LEE
Last Name:CAVILL
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 W 48TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-1277
Mailing Address - Country:US
Mailing Address - Phone:308-708-9290
Mailing Address - Fax:
Practice Address - Street 1:1755 PRAIRIE VIEW PL
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-8300
Practice Address - Country:US
Practice Address - Phone:308-865-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11513101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health