Healthcare Provider Details

I. General information

NPI: 1093524423
Provider Name (Legal Business Name): CALEB DANIEL STEELE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 BROADWAY ST
LONGVIEW WA
98632-3831
US

IV. Provider business mailing address

1116 14TH AVE
LONGVIEW WA
98632-3017
US

V. Phone/Fax

Practice location:
  • Phone: 360-261-6930
  • Fax:
Mailing address:
  • Phone: 360-261-6930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCPSS.PR.70055873
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: