Provider Demographics
NPI:1982321220
Name:CICADA FAMILY THERAPY & CONSULTING, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CICADA FAMILY THERAPY & CONSULTING, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GAVIDIA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMFT
Authorized Official - Phone:818-732-9884
Mailing Address - Street 1:18411 DEVLIN AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-5727
Mailing Address - Country:US
Mailing Address - Phone:818-732-9884
Mailing Address - Fax:
Practice Address - Street 1:18411 DEVLIN AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-5727
Practice Address - Country:US
Practice Address - Phone:818-732-9884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty