Provider Demographics
NPI:1932882636
Name:GAVIN, ANN M (LMFT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:GAVIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 COLLINS RD NE STE 205
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3167
Mailing Address - Country:US
Mailing Address - Phone:319-320-7506
Mailing Address - Fax:
Practice Address - Street 1:373 COLLINS RD NE STE 205
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3167
Practice Address - Country:US
Practice Address - Phone:319-320-7506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA107879106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty