Basic Information
| Provider Information | |||||||||
| NPI: | 1801166616 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAVANAUGH | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 560 N EXPOSITION ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672035902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162648317 | ||||||||
| FaxNumber: | 3162640347 | ||||||||
| Practice Location | |||||||||
| Address1: | 560 N EXPOSITION ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672035902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162648317 | ||||||||
| FaxNumber: | 3162640347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2012 | ||||||||
| LastUpdateDate: | 02/07/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 2352 | KS | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.