MEDICARE: ETHOS BEHAVIORAL HEALTH & CONSULTING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1558203703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETHOS BEHAVIORAL HEALTH & CONSULTING, LLC

Provider Business Mailing Address
First Line	:	5441 S MACADAM AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-6106
Country	:	US
Telephone Number	:	541-939-3709
Fax Number	:

Provider Business Practice Location Address
First Line	:	1590 WILSON CT
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97402-3359
Country	:	US
Telephone Number	:	541-939-3709
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	BONNIE JEAN CAPPA
Credential	:	LCSW
Telephone Number	:	541-939-3709

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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