Provider Demographics
NPI:1528766649
Name:CAPPARELLI, PAYTON (CADC-R)
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:
Last Name:CAPPARELLI
Suffix:
Gender:F
Credentials:CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 NE LINDEN AVE # D34
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3933
Mailing Address - Country:US
Mailing Address - Phone:503-481-4686
Mailing Address - Fax:
Practice Address - Street 1:22518 S PARROT CREEK RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-9725
Practice Address - Country:US
Practice Address - Phone:503-266-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-22-2078101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT-22-2078OtherCADC-R