Provider Demographics
NPI:1295572360
Name:EGGLESTON, CALEB
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:EGGLESTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 S 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-8731
Mailing Address - Country:US
Mailing Address - Phone:417-689-3183
Mailing Address - Fax:
Practice Address - Street 1:283 US HIGHWAY 60 W
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1432
Practice Address - Country:US
Practice Address - Phone:417-216-6189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024018840101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty