Provider Demographics
NPI:1972690733
Name:CAVE, KATHLEEN L (MFT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:L
Last Name:CAVE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32391 MILL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437
Mailing Address - Country:US
Mailing Address - Phone:707-964-0554
Mailing Address - Fax:707-961-6230
Practice Address - Street 1:32391 MILL CREEK DR
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437
Practice Address - Country:US
Practice Address - Phone:707-964-0554
Practice Address - Fax:707-961-6230
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 27073106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist