Provider Demographics
NPI:1609246693
Name:WILNER, CALEB WALTER
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:WALTER
Last Name:WILNER
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 1:805 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4640
Mailing Address - Country:US
Mailing Address - Phone:530-877-5845
Mailing Address - Fax:
Practice Address - Street 1:805 CEDAR ST
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4640
Practice Address - Country:US
Practice Address - Phone:530-877-5845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health