Provider Demographics
NPI:1346023967
Name:FEATHERSTONE, CALEB HENDRIK
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:HENDRIK
Last Name:FEATHERSTONE
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 1:841 E 1010 S
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4061
Mailing Address - Country:US
Mailing Address - Phone:435-705-4312
Mailing Address - Fax:
Practice Address - Street 1:841 E 1010 S
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4061
Practice Address - Country:US
Practice Address - Phone:435-705-4312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID9741106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist