MEDICARE: CAITLYN EID

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	101YM0800X	Mental Health Counselor	R11014	OR

General Provider Information

NPI Number	:	1003538141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLYN EID

Provider Business Mailing Address
First Line	:	1524 NE 48TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-2138
Country	:	US
Telephone Number	:	337-654-0552
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 NE IRVING ST STE 210
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-2243
Country	:	US
Telephone Number	:	971-220-5846
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2022
Last Update Date	:	12/09/2025

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Directions to “ CAITLYN EID ” Practice Location

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