Healthcare Provider Details

I. General information

NPI: 1174272363
Provider Name (Legal Business Name): CAITLIN ALYS GOODEILL AAC, SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date: 03/04/2026
Reactivation Date: 04/16/2026

III. Provider practice location address

151 N MARKET BLVD
CHEHALIS WA
98532-2677
US

IV. Provider business mailing address

1743 SW KELLY AVE
CHEHALIS WA
98532-3824
US

V. Phone/Fax

Practice location:
  • Phone: 360-948-0203
  • Fax:
Mailing address:
  • Phone: 360-304-1160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO61285861
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG61417689
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: