Provider Demographics
NPI:1053078949
Name:CASTRO, SAMANTHA REBEKAH
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:REBEKAH
Last Name:CASTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S DIVISION ST STE A
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-3800
Mailing Address - Country:US
Mailing Address - Phone:509-764-6644
Mailing Address - Fax:
Practice Address - Street 1:521 AUVIL RD
Practice Address - Street 2:
Practice Address - City:VANTAGE
Practice Address - State:WA
Practice Address - Zip Code:98950
Practice Address - Country:US
Practice Address - Phone:509-607-9281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician