Provider Demographics
NPI:1679607717
Name:BURNS, CALEB (PHD)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:BURNS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2154 NE BROADWAY ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1561
Mailing Address - Country:US
Mailing Address - Phone:503-288-4558
Mailing Address - Fax:503-288-4558
Practice Address - Street 1:2154 NE BROADWAY ST
Practice Address - Street 2:SUITE 110
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1561
Practice Address - Country:US
Practice Address - Phone:503-288-4558
Practice Address - Fax:503-288-4558
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR743103TC0700X
WA2803103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical