Provider Demographics
NPI:1235817156
Name:CASTILLO, MYRA NIKIRA (LPC)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:NIKIRA
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8213 W MIAMI ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-1571
Mailing Address - Country:US
Mailing Address - Phone:602-561-5612
Mailing Address - Fax:
Practice Address - Street 1:8213 W MIAMI ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-1571
Practice Address - Country:US
Practice Address - Phone:602-561-5612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21912101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health