| Doctor Name: | MS. CAELIN ELIZA JOHNSON-LUPES |
| NPI Number: | 1215338934 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | A3474 |
| Business Practice Address: | 8385 Division Rd White City, OR - 975031176 |
| Business Phone Number: | 5418265853 |
| Business Fax Number: | 5418265843 |
| Mailing Address: | 8385 Division Rd, WHITE CITY |
| State: | OR |
| Postal Code: | 975031176 |
| Phone Number: | 5418265853 |
| Fax Number: | 5418265843 |
| NPI Enumeration Date: | 09/12/2014 |
| NPI Last Update Date: | 02/23/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | A3474 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |