Provider Demographics
NPI:1215542501
Name:CALDWELL ELEAZER, MAYA ELIZABETH
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:ELIZABETH
Last Name:CALDWELL ELEAZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:INDEX
Mailing Address - State:WA
Mailing Address - Zip Code:98256-0101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 101
Practice Address - Street 2:
Practice Address - City:INDEX
Practice Address - State:WA
Practice Address - Zip Code:98256-0101
Practice Address - Country:US
Practice Address - Phone:360-381-2354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-13
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH6611185101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH61611185OtherLICENSED MENTAL HEALTH COUNSELOR