Provider Demographics
NPI:1053431429
Name:REGINA CAVANAUGH, M.D.
Entity type:Organization
Organization Name:REGINA CAVANAUGH, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:CAVANAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:254-698-2216
Mailing Address - Street 1:775 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-7025
Mailing Address - Country:US
Mailing Address - Phone:254-698-2216
Mailing Address - Fax:254-698-2296
Practice Address - Street 1:775 INDIAN TRL
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-7025
Practice Address - Country:US
Practice Address - Phone:254-698-2216
Practice Address - Fax:254-698-2296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4031103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty