Provider Demographics
NPI:1811431646
Name:CAVEN, CANDACE (MED)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:CAVEN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 CAMPBELLSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:42743-8898
Mailing Address - Country:US
Mailing Address - Phone:270-937-0157
Mailing Address - Fax:270-592-1394
Practice Address - Street 1:2680 CAMPBELLSVILLE RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-8898
Practice Address - Country:US
Practice Address - Phone:270-937-0157
Practice Address - Fax:270-592-1394
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY165429101YP2500X
KY245954101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional