MEDICARE: CAITLYN WOODHOUSE LPCC

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	4241	CA
2	101YP2500X	Professional Counselor	4241	CA
3	101YP2500X	Professional Counselor	9441	CA

General Provider Information

NPI Number	:	1104372044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLYN WOODHOUSE LPCC

Provider Business Mailing Address
First Line	:	PO BOX 2765
Second Line	:
City	:	HOLLISTER
State	:	CA
Zip	:	95024-2765
Country	:	US
Telephone Number	:	408-202-3918
Fax Number	:

Provider Business Practice Location Address
First Line	:	2660 SOLACE PL STE D2
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-4337
Country	:	US
Telephone Number	:	408-202-3918
Fax Number	:

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

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	03/31/2021

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