Basic Information
Provider Information
NPI: 1033559703
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PEOPLES
FirstName: CAITLIN
MiddleName:  
NamePrefix: MISS
NameSuffix:  
Credential: M.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3995 MARCOLA RD
Address2:  
City: SPRINGFIELD
State: OR
PostalCode: 974777948
CountryCode: US
TelephoneNumber: 5417261465
FaxNumber: 5417265085
Practice Location
Address1: 3995 MARCOLA RD
Address2:  
City: SPRINGFIELD
State: OR
PostalCode: 974777948
CountryCode: US
TelephoneNumber: 5417261465
FaxNumber: 5417265085
Other Information
ProviderEnumerationDate: 06/26/2013
LastUpdateDate: 06/26/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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