Provider Demographics
NPI:1144358797
Name:KAVANAUGH, MICHAEL THOMAS II (BS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:KAVANAUGH
Suffix:II
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3406 OAK CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-2606
Mailing Address - Country:US
Mailing Address - Phone:615-889-1152
Mailing Address - Fax:
Practice Address - Street 1:915 8TH AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-2621
Practice Address - Country:US
Practice Address - Phone:615-460-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health