Provider Demographics
NPI:1205214293
Name:CASTILLO, JAMIE (LPC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:RINGELBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:300 68TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-6927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 68TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-6927
Practice Address - Country:US
Practice Address - Phone:616-455-5000
Practice Address - Fax:616-455-5960
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401222372101Y00000X
COLPC.0013275101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor