Provider Demographics
NPI:1821340464
Name:THE CENTER FOR FAMILY THERAPY AND ASSESSMENT LLC
Entity Type:Organization
Organization Name:THE CENTER FOR FAMILY THERAPY AND ASSESSMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:CAVANAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:817-992-8034
Mailing Address - Street 1:725 NW SANDRA LN
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-3741
Mailing Address - Country:US
Mailing Address - Phone:817-992-8034
Mailing Address - Fax:
Practice Address - Street 1:725 NW SANDRA LN
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-3741
Practice Address - Country:US
Practice Address - Phone:817-992-8034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60121101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty