Provider Demographics
NPI:1376915686
Name:CABALLERO, EDGAR JULIAN (LPC)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:JULIAN
Last Name:CABALLERO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64682 COOK AVE # 1
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-9033
Mailing Address - Country:US
Mailing Address - Phone:541-357-7686
Mailing Address - Fax:
Practice Address - Street 1:19855 4TH ST STE 106
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7814
Practice Address - Country:US
Practice Address - Phone:541-357-7686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor