Provider Demographics
NPI:1437748779
Name:BOSTON, CALEB (MS)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:BOSTON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5549 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MO
Mailing Address - Zip Code:65617-7256
Mailing Address - Country:US
Mailing Address - Phone:417-376-2238
Mailing Address - Fax:
Practice Address - Street 1:5549 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MO
Practice Address - Zip Code:65617-7256
Practice Address - Country:US
Practice Address - Phone:417-376-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020041801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health