Provider Demographics
NPI:1669032223
Name:JUSTIS, CAITLYN (QMHS)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:JUSTIS
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:
Other - Last Name:HOLTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-0188
Mailing Address - Country:US
Mailing Address - Phone:740-773-4366
Mailing Address - Fax:740-773-4750
Practice Address - Street 1:112 E MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:OH
Practice Address - Zip Code:45769-9569
Practice Address - Country:US
Practice Address - Phone:740-992-2192
Practice Address - Fax:740-992-4018
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2864002Medicaid
OH2314525Medicaid