Provider Demographics
NPI:1699048355
Name:CAVANAL COUNSELING
Entity type:Organization
Organization Name:CAVANAL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TORI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MED LPC
Authorized Official - Phone:918-413-2058
Mailing Address - Street 1:2104 N BROADWAY ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-2538
Mailing Address - Country:US
Mailing Address - Phone:918-647-0485
Mailing Address - Fax:918-647-0571
Practice Address - Street 1:2104 N BROADWAY ST UNIT A
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2538
Practice Address - Country:US
Practice Address - Phone:918-647-0485
Practice Address - Fax:918-647-0571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health