Provider Demographics
NPI:1407623465
Name:CAVILLO, CYSTRAL C
Entity Type:Individual
Prefix:
First Name:CYSTRAL
Middle Name:C
Last Name:CAVILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CYSTRAL
Other - Middle Name:
Other - Last Name:JUAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18600 SE MCLOUGHLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-6723
Mailing Address - Country:US
Mailing Address - Phone:971-255-0658
Mailing Address - Fax:971-236-8080
Practice Address - Street 1:224 MARTIN ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4542
Practice Address - Country:US
Practice Address - Phone:208-543-7230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)