Active NPI
James Michael Kavanaugh, PH.D.
- Clinical Psychologist
- Durango, CO
National Provider Identifier
1497857338
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3158
- Practice address
- 2243 Main Ave Ste 4F
Durango, CO 81301-4699 - Phone
- (505) 995-0635
- NPI assigned
- Sep 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3158 | CO | Primary |
Addresses
Primary practice location
2243 Main Ave Ste 4F
Durango, CO 81301-4699
Mailing address
977 County Road 243
Durango, CO 81301-8381
Phone (970) 317-5014
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250128000571 | CO | Practitioner - Clinical Psychologist | 9032193503 | Practice locations: Durango, CO |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3158 | CO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714608000000",
"number": "1497857338",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "977 COUNTY ROAD 243",
"city": "DURANGO",
"state": "CO",
"postal_code": "813018381",
"telephone_number": "970-317-5014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2243 MAIN AVE STE 4F",
"city": "DURANGO",
"state": "CO",
"postal_code": "813014699",
"telephone_number": "505-995-0635"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAVANAUGH",
"first_name": "JAMES",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-01",
"last_updated": "2024-05-02",
"certification_date": "2023-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "3158",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Durango, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.