Provider Demographics
NPI:1003999111
Name:CASTILLO, CARLOS LUIS (MA LPC)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:LUIS
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 COLONY DR STE 125
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2365
Mailing Address - Country:US
Mailing Address - Phone:210-212-7353
Mailing Address - Fax:121-021-2735
Practice Address - Street 1:3740 COLONY DR STE 125
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2365
Practice Address - Country:US
Practice Address - Phone:210-212-7353
Practice Address - Fax:121-021-2735
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16074101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health