Provider Demographics
NPI:1396985875
Name:CAVETT, CHARLES L (LPC, AAMFT,PHD, PSYD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:CAVETT
Suffix:
Gender:M
Credentials:LPC, AAMFT,PHD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 N BLUE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-8058
Mailing Address - Country:US
Mailing Address - Phone:405-701-1090
Mailing Address - Fax:405-701-1095
Practice Address - Street 1:9901 S WESTERN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2951
Practice Address - Country:US
Practice Address - Phone:405-412-7189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPC#4095172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200412200AMedicaid