Provider Demographics
NPI:1780200261
Name:CAV FAMILY THERAPY INC
Entity Type:Organization
Organization Name:CAV FAMILY THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:C
Authorized Official - Last Name:SEGISMUNDO
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-247-8820
Mailing Address - Street 1:285 IMPERIAL HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1048
Mailing Address - Country:US
Mailing Address - Phone:909-247-8820
Mailing Address - Fax:
Practice Address - Street 1:5011 ARGOSY AVE STE 9
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-1002
Practice Address - Country:US
Practice Address - Phone:909-247-8820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA103T00000XMedicaid
CA106H00000XMedicaid