Provider Demographics
NPI:1053772517
Name:KAVA, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KAVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:CASTLE DALE
Mailing Address - State:UT
Mailing Address - Zip Code:84513-0223
Mailing Address - Country:US
Mailing Address - Phone:435-381-5607
Mailing Address - Fax:
Practice Address - Street 1:215 EAST 300 SOUTH
Practice Address - Street 2:
Practice Address - City:CASTLE DALE
Practice Address - State:UT
Practice Address - Zip Code:84513-0223
Practice Address - Country:US
Practice Address - Phone:435-381-5607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor