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Individual

JAMES JOSEPH CAVANAUGH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LADC

Contact information

Practice address
11900 WAYZATA BLVD STE 100, MINNETONKA, MN 55305-2018
(612) 454-2058
(952) 546-1683
Mailing address
11900 WAYZATA BLVD STE 100, MINNETONKA, MN 55305-2018
(612) 454-2058
(952) 546-1683

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
302366
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1922448620
NPI
Enumeration date
02/14/2019
Last updated
02/14/2019
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