Provider Demographics
NPI:1639041148
Name:KAVANAUGH, WILLIAM JACOB (LMFT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JACOB
Last Name:KAVANAUGH
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2466 BOW CIR
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-1411
Mailing Address - Country:US
Mailing Address - Phone:714-269-6092
Mailing Address - Fax:
Practice Address - Street 1:2466 BOW CIR
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-1411
Practice Address - Country:US
Practice Address - Phone:714-269-6092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA155237106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist