Provider Demographics
NPI:1346871340
Name:CASTILLO, KAYLA CHRISTINE
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:CHRISTINE
Last Name:CASTILLO
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 1:1138 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-8869
Mailing Address - Country:US
Mailing Address - Phone:970-689-2345
Mailing Address - Fax:
Practice Address - Street 1:710 11TH AVE STE L46
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-3171
Practice Address - Country:US
Practice Address - Phone:970-689-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health