Pete Kavanaugh, SUDRC15061
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Clearlake Oaks, CA
NPI 1649974759 · NPPES record last updated Mar 30, 2023
Key facts
- NPI
- 1649974759
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- SUDRC15061 (CA)
- Practice address
- 14715 East Hwy 20
Clearlake Oaks, CA 95423 - Phone
- (707) 998-1800
- NPI assigned
- Mar 30, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SUDRC15061 | CA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hilltop Recovery Services | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | SUDRC15061 | CA | Yes |
Addresses
Primary practice location
14715 East Hwy 20
Clearlake Oaks, CA 95423
Mailing address
PO Box 366
Clearlake Oaks, CA 95423-0366
Other providers in Clearlake Oaks, CA
- Christy Lyree Hernandez
- Hilltop Recovery Services
- Jewellie Anna Hyatt
- Sara Lynne Ivans
- Kenneth D Johnson
- Jennifer Lynn Kraus
- Lake County Office of Education
- Summer C Lentz
- Paige Nicole Logan
- Patricia Anne Marceleno
All providers in Clearlake Oaks, CA · Addiction (Substance Use Disorder) Counselor in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.