Healthcare Provider Details

I. General information

NPI: 1992390694
Provider Name (Legal Business Name): MRS. CAITLIN ELIZABETH SUNDIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 E 1ST ST
PORT ANGELES WA
98362-4012
US

IV. Provider business mailing address

240 W FRONT ST
PORT ANGELES WA
98362-2609
US

V. Phone/Fax

Practice location:
  • Phone: 360-452-7891
  • Fax:
Mailing address:
  • Phone: 360-452-7891
  • Fax: 360-452-8087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61442274
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLH61442274
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLH61442274
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: