Provider Demographics
NPI:1013185891
Name:CASTRILLO, MARCOS DONALD
Entity Type:Individual
Prefix:MR
First Name:MARCOS
Middle Name:DONALD
Last Name:CASTRILLO
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:PO BOX 7118
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71306-0118
Mailing Address - Country:US
Mailing Address - Phone:318-484-6822
Mailing Address - Fax:
Practice Address - Street 1:242 W. SHAMROCK
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71361
Practice Address - Country:US
Practice Address - Phone:318-484-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9095101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional