Provider Demographics
NPI:1669281051
Name:CAGLE, COLTON
Entity type:Individual
Prefix:
First Name:COLTON
Middle Name:
Last Name:CAGLE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 LA PALOMA LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1964
Mailing Address - Country:US
Mailing Address - Phone:831-454-6243
Mailing Address - Fax:
Practice Address - Street 1:4 ROSSI CIR STE 101
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93907-2358
Practice Address - Country:US
Practice Address - Phone:831-424-5565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician